Coding Essentials for Laboratories

Whether it’s pinpointing the correct CPT®/HCPCS code for a pathology service, or avoiding noncompliant billing practices, you won’t find an easier to use or more complete resource anywhere else!

Price range: $275.00 through $299.00

Coding Essentials for Laboratories

Price range: $275.00 through $299.00

A renowned resource for streamlined coding efficiency and effective payment outcomes

As healthcare facilities face ongoing challenges, you need more than a guide to laboratory coding and billing. Mounting complexity, confusing new rules, and continued reductions in reimbursements require a comprehensive solution — this is exactly what you get with our Coding Essentials for Laboratories.

Did you know that some of the new PLA codes coincide with Category I CPT® codes, increasing the potential for mistakes and payment denials? Are you aware of the ramped-up scrutiny by payers looking for noncompliant practices, such as stacking CPT codes for multi-gene NGS panels? Likewise, Recovery Audit Contractors (RACs) could target some laboratory tests for proof of documentation to support medical necessity. With over twenty years of nationally recognized expertise, you can trust that we will deliver the latest guidance for correct reporting.

Unlock a time-trusted resource to guide you quickly to the correct codes for laboratory and pathology services.

Features and Benefits

  • Explanations and practical application of code changes and any pertinent policy updates
  • Experience enhanced coding instruction for assignment of Molecular Pathology targeted gene CPT and NGS panel CPT
  • Guidance for Proprietary Laboratory Analyses (PLA) codes; covers the expansion of PLA codes that appear to match Category I CPT codes — a scenario with a high risk for confusion, miscoding and claim denials
  • Guidance with coding instruction contained in the latest NCCI Policy narrative that provides a foundation for claim denials as well as payer audits
  • Scenarios where clinical pathology consultations may impact documentation and coding of laboratory procedures
  • Updated payment information
Our experts address common questions, concerns and problem areas:
  • Coding for diagnostic vs. preventive Pap smears
  • Coverage limitations that are increasing claim denials
  • Coding for molecular pathology
  • Proper use of modifiers for billing of laboratory and pathology procedures
Clear, step-by-step guidance through the tasks you perform every day:
  • Coding and billing for laboratory and pathology services:
    • Drug testing
    • Therapeutic drug assays
    • Molecular pathology
    • Chemistry
    • Microbiology
    • Preventive services
    • Hematology
    • Immunology
    • Transfusion medicine
    • Cytogenetics
    • Histology
    • And more
A proven quick-reference approach for busy professionals:
  • Coding flowcharts for at-a-glance guidance with selecting the correct CPT codes, along with examples of CPT codes to reinforce the correct choices
  • Each section includes:
    • Explanations of services and the intent of each
    • CPT/HCPCS codes and descriptions
    • Sample chargemasters
    • Coding and billing tips
    • Visual flow charts
    • Medicare payment information, including quick-reference tables with RVU and APC rates

Looking for more valuable coding education and news? Check out our Laboratory All-Access Pass for a full range of comprehensive educational resources that provide the best protection for your bottom line.


CPT® is a registered trademark of the American Medical Association.

For certain MedLearn Publishing publications, you will see an 'AMA Royalty Fee' in your shopping cart. This charge covers the licensing fee MedLearn Publishing pays to the American Medical Association (AMA) for references to CPT® codes. The AMA owns the copyright for CPT codes.

*All-Access Pass subscribers receive 30% off the print version of the books included with their membership. This 30% does not include AMA fees or shipping and handling fees. For questions please email us.

**Please note that eBooks cannot be printed, and all sales on eBooks are final. If you would like a printed copy of this resource please select the Print version and allow time for shipping.

***This book is on pre-order and is estimated to start shipping end of January 2026.

Introduction
  • New Way of Thinking
  • Future of Reimbursement
  • CPT Coding Guidelines
  • CPT Terminology Format
  • Coding Flowcharts
    • Quantitative Qualitative
    • Specimen Codes
    • Each Specimen or Each Analyte
    • Free and Total Studies
    • Screen and “Only” Tests
    • Each Antigen or Each Antibody
    • Antigens or Antibodies
    • With or Without Studies
    • In Addition Studies
  • Category III CPT Codes
  • HCPCS Alternate Codes
  • Revenue Center Codes
    • Modifiers
  • National Correct Coding Initiative
    • Procedure-to-Procedure Edits
    • Add-on Edits
  • Medically Unlikely Edits
  • Other Coding Guidance
    • National Coverage Determinations
    • Local Coverage Determinations
  • Routine Screening Tests
  • Reasonable and Necessary Denials
  • Frequency Limits
  • Tests Not Ordered by Qualified Provider
  • Diagnosis Coding Guidelines for Labs
  • ICD-10 Coding System
  • CLIA Compliance
  • Medicare Packaging of Lab Tests
Chapter 1: Organ and Disease Panels
  • Standard and Custom Panels
  • Screening Tests
  • Duplicate Billing
  • ESRD Composite Rate Billing
  • Organ or Disease-Oriented Panels
  • Billing and Coding Tips
  • Coding Changes for 2026
Chapter 2: Drug Testing
  • Drugs of Abuse Analysis
  • Presumptive Drug Analysis
    • Reporting of Presumptive Drug Analysis
  • Definitive Drug Analysis
    • Reporting of Definitive Drug Analysis
    • Opioids and Opiate Analogs
  • Billing and Coding Tips
  • Coding Changes for 2026
    • Additions
    • Deletion
Chapter 3: Therapeutic Drug Assays
  • Multiple Tests
  • Unlisted Tests
  • Billing and Coding Tips
  • Coding Changes for 2026
    • Addition
Chapter 4: Urinalysis
  • Routine Urinalysis
  • Other Urinalysis
  • Coding Flowchart
  • Billing and Coding Tips
  • Coding Changes for 2026
Chapter 5: Molecular Pathology
  • Tier 1/Tier 2
  • Geonomic Sequencing Procedures and Other Molecular Analyte Assays
  • Multianalyte Algorithmic Assay
  • Proprietary Laboratory Analyses
  • Professional Interpretation
  • ADLT Date of Service
  • Payment
  • Coding Changes for 2026
    • Additions
    • Revisions
    • Deletions
Chapter 6: Chemistry Testing
  • Custom Profiles and AMA-Defined Panels
  • Comprehensive Codes
  • When the Specimen Matters
  • When the Method Matters
  • Frequency, Overutilization and Medical Necessity
    • Example: Blood Glucose Testing
  • Billing and Coding Tips
  • Coding Changes for 2026
    • Revisions
    • Deletion
Chapter 7: Hematology
  • Standardized Chargemaster for Multisite Facilities
  • Customizing Test Descriptions
  • Chargemaster-Driven Overutilization
  • Compliance Issues
    • Reflex Testing vs. Quality Assurance
    • Prescription Pad Orders
  • Coding Flowchart
  • Billing and Coding Tips
  • Coding Changes for 2026
Chapter 8: Coagulation Testing
  • Custom Profiles and Panels
  • Medical Necessity Versus Screening
  • Standing Orders Versus Recurring Orders
  • Frequency Limits and Overutilization
  • Coding Flowchart
  • Billing and Coding Tips
  • Coding Changes for 2026
    • Addition
Chapter 9: Immunology
  • Compliance Issues
    • Reflex Testing
    • NCCI and Medically Unlikely Edits
    • Authoritative Resources
  • Billing and Coding Tips
  • Coding Changes for 2026
Chapter 10: Microbiology
  • Matching Order Options to the Chargemaster
  • Submitting Follow-up Test Codes
  • Culture of Pathogen and Detection of Infectious Agent
  • Infectious Antigen Detection
  • To Recap the Issues
  • Coding Flowchart
  • Billing and Coding Tips
  • Coding Changes for 2026
    • Additions
    • Deletions
Chapter 11: Blood Banking and Transfusion Medicine
  • Billing for the Blood Product
  • Crossmatch Codes
  • Retyping the Units
    • Code Assignment for Transfusion Medicine Services
  • Blood Transfusions
  • Billing and Coding Tips
  • Coding Changes for 2026
Chapter 12: Cytopathology
  • Non-Gynecological Specimens
    • CPT/HCPCS Codes
    • Intended Use of Codes
  • Billing and Coding Tips
  • Gynecological Specimens
    • CPT/HCPCS Codes
    • Intended Use of Codes
  • Billing and Coding Tips
  • Coding Changes for 2026
  • Fine Needle Aspirate
    • CPT/HCPCS Codes
    • Intended Use of Codes
  • Billing and Coding Tips
  • Coding Changes for 2026
  • Flow Cytometry
    • CPT/HCPCS Codes
  • Billing and Coding Tips
  • Coding Changes for 2026
Chapter 13: Cytogenetic Studies
  • Coding Flowchart
  • Billing and Coding Tips
  • Coding Changes for 2026
Chapter 14: Surgical Pathology and Histology
  • Outpatient Payment and APCs
  • Unit of Service
    • Date of Service Rules for Histology
  • Specimen Processing, Special Stains and Other Related Procedures
  • Billing and Coding Tips
  • Frozen Section
    • CPT/HCPCS Codes
    • Intended Use of Codes
    • Billing and Coding Tips
  • Touch Prep
    • CPT/HCPCS Codes
    • Intended Use of Codes
    • Billing and Coding Tips
  • Antibody Techniques
    • CPT/HCPCS Codes
    • Intended Use of Codes
    • Billing and Coding Tips
  • Bone Marrow Studies
  • Prostate Biopsy Mapping Specimens
  • Morphometric Analysis
    • CPT/HCPCS Codes
    • Intended Use of Codes
    • Billing and Coding Tips
  • Nerve Teasing
    • CPT/HCPCS Codes
    • Intended Use of Codes
    • Billing and Coding Tips
  • In situ Hybridization
    • CPT/HCPCS Codes
    • Intended Use of Codes
    • Billing and Coding Tips
  • Protein Analysis of Tissue by Western Blot
    • CPT/HCPCS CodesIntended Use of Codes
    • Billing and Coding Tips
  • Dissection and Microdissection Procedures
    • CPT/HCPCS Codes
    • Intended Use of Codes
    • Billing and Coding Tips
  • Postmortem Examination
    • CPT/HCPCS Codes
    • Intended Use of Codes
    • Billing and Coding Tips
  • Coding Changes for 2026
Chapter 15: In Vivo (Transcutaneous) Procedures, Miscellaneous Testing, Reproductive Medicine
  • Handling or Shipping Fees
  • In Vivo (Transcutaneous) Procedures
  • Specimen Collection (Venipunctures, Finger-sticks and Arterial Punctures)
  • Travel Allowance
  • Continuous Glucose Monitoring (CGM)
  • Billing and Coding Tips
  • Coding Changes for 2026
Chapter 16: Preventive Screening Procedures
  • Prostate Antigen Screening for Adenocarcinoma
  • Fecal Occult Blood Screening for Colorectal Cancer
  • Blood-Based Biomarker Screening for Colorectal Cancer
  • Measurement of Lipid Levels to Screen for Cardiovascular Disease
  • Diabetes Screening
  • Human Immunodeficiency Virus
  • Sexually Transmitted Infections (STIs)
  • Hepatitis C Virus Screening
  • Billing and Coding Tips
Chapter 17: Category III CPT for Pathology Related Services
  • Billing and Coding Tips
  • Coding Changes for 2026
Chapter 18: Payment Methods for Clinical Laboratory and Professional Services
  • Pathology Payment Methods
    • Column 1: HCPCS
    • Column 2: Mod (Modifier)
    • Column 3: MPFS Status Code
    • Column 4: MPFS PC/TC Indicator
    • Column 5: MPFS Work RVU
    • Column 6: MPFS Facility RVU
    • Column 7: Non-Facility RVU
    • Column 8: MPFS Conversion Factor
    • Column 9: OPPS Status Indicator
    • Column 10: OPPS APC Rate
    • Column 11: CLFS 2026 Payment
  • Clinical Pathology Consultations
  • Consultations on Referred Material
Appendix A: Medicare Manuals
Appendix B: Artificial Intelligence Taxonomy
Product SKU PCEL
Product Categories Books
Specialties and Topics Laboratory

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