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