Specialty Billing Built for Pathology Practices

Immunohistochemistry (88342) is billed per antibody and in situ hybridization / FISH (88367) is billed per probe — each special study is a separately reportable add-on to the base surgical pathology code. Each IHC antibody and FISH probe must be linked to a supporting diagnosis that establishes medical necessity, or the payer bundles and denies it. Special stains (88312/88313) follow the same per-study rule. We bill every special study separately with diagnosis-linked documentation so add-on revenue is not under-billed or denied as bundled into the base case.

Flow cytometry technical component billing is 88184 for the first marker plus 88185 for each additional marker on the same date of service — so 10 markers bill as 88184 x1 and 88185 x9. The professional interpretation is reported with a single code based on the total number of markers interpreted: 88187 (2–8 markers), 88188 (9–15), or 88189 (16 or more). More than one interpretation code per date of service is generally not medically necessary. We sequence 88184/88185 correctly and select the right interpretation code per marker range so flow cytometry is paid at the correct unit count.

Surgical pathology is billed across six ascending complexity levels (88300–88309). 88305 (Level IV) is the routine, most-common code for typical biopsies and specimens. 88307 (Level V) covers intermediate complexity such as cervical conization, sentinel lymph nodes, and brain biopsies. 88309 (Level VI) covers the most complex cases such as malignant multi-specimen resections (e.g., colon resection with tumor). The level is determined by the pathologist’s gross and microscopic work, not by the referring diagnosis alone. We select the level that reflects actual work performed so complex cases are not under-coded as routine.

Screening and diagnostic Pap tests use the same CPT codes (88141–88147) but different diagnoses and coverage rules. Screening Paps (Z12.4, Z01.419) are typically covered under preventive benefits with frequency limits, while diagnostic Paps (N72, R89.x, or a symptomatic diagnosis) are billed to medical necessity without the screening limit. 88141 is the physician interpretation add-on when lab screening personnel flag an abnormality and the pathologist reviews it. We confirm whether each case is screening or diagnostic from the order and diagnosis so the claim is paid under the correct coverage pathway.

We integrate with all major laboratory information systems (LIS) and EMR/practice-management platforms including Epic, Cerner, Athenahealth, Orchard, CoPathPlus, and reference-lab reporting systems. Our team works with your specimen accessioning, grossing, and special-study order data so the surgical path level, 26/TC component, and every IHC/FISH/flow add-on flow cleanly to correct claim submission — including the per-study detail and diagnosis linkage that drive accurate pathology coding.