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Claims edit to go into effect May 29, 2019

04/02/2019

The following claims edit will go into effect May 29, 2019:

Policy: Surgical pathology

Policy description: CPT codes 88305-88309 should be reported with the diagnosis code for the tissue specimen that matches the CPT code description. A surgical pathology service will be denied if the only reported diagnosis reflects a tissue specimen that does not qualify for the level of surgical pathology service billed.

Reference: AMA CPT Manual; American Society for Clinical Pathology: Laboratory Medicine, Volume 42, Issue 4, April 2011.

Plans affected: ConnectiCare commercial and Medicare Advantage plans