New Digital Pathology Codes for 2024: Your Pathway to Maximize Reimbursement

The College of American Pathologists (CAP), in collaboration with the American Medical Association (AMA) CPT Editorial Panel, has successfully pushed for the inclusion of 30 new digital pathology add-on codes, effective from January 1, 2024. This addition will expand the range of digital pathology services that can be separately reported to a total of 43 services.

The 43 Category III add-on codes (0751T-0763T, established in 2023, and the new 2024 codes 0827T-0856T) are intended to capture and report the additional clinical staff work and service requirements associated with the digitization of glass microscope slides for primary diagnosis.

The 2024 revised Digital Pathology CPT instructions now clarify that each Category III add-on code should be reported as a one-to-one unit of service for each primary pathology service code.

Digital Pathology Benefits and Reimbursement

Digital pathology is a branch of pathology that involves the use of digital technology to capture, manage, and analyze pathology data, including tissue samples, slides, and medical images. It replaces traditional microscopic examination of tissue samples with digital methods. Digital pathology offers numerous benefits including:

• Expanded Collaboration: Digital pathology allows pathologists and other healthcare professionals to collaborate remotely. This is especially valuable for consultations and second opinions, reducing the need for physical presence and facilitating collaboration across different locations and even countries.
• Efficient Workflow: Digital pathology streamlines the workflow in pathology laboratories. It eliminates the need for physical slide transport, storage, and retrieval. Digital slides can be quickly accessed and shared electronically, saving time and resources
• Enhanced Analysis: The transition to digital pathology opens up avenues for in-depth analysis of slides using digital tools. Ongoing developments in AI applications make it possible to overlay these images, thereby analyzing the data, enhancing diagnostic capabilities, and revealing valuable insights.

Digital pathology has long held great promise, but reimbursement issues, regulatory challenges, and other roadblocks prevented it from reaching its full potential. The challenge with digital pathology so far has been that it requires a shift in the way labs work; digitizing glass slides means more work for the clinical staff and additional service requirements, which can be time consuming. Yet there has been no mechanism to seek reimbursement for this time and effort. The establishment of digital pathology CPT codes is the first step toward changing that.

Billing for Data Collection Versus Reimbursement

It’s important to note that the digital pathology codes fall under Category III, which are temporary codes for emerging technology, and should be reported in addition to the associated applicable Category l CPT code. Category lll codes allow for data collection and do not have an assigned Relative Value Unit (RVU). Consequently, payments for these services or procedures are determined by the policies of payors and are not based on annual fee schedules.

While Medicare contractors and commercial payors have not yet released payment policies for these new codes, the next step in establishing reimbursement for digital pathology codes is for providers performing digital pathology to begin billing these codes which will enable payors to identify instances where a diagnosis was made using digital pathology. This marks a significant initial step for payors to assess utilization and its impact.

Several XiFin customers performing digital pathology have begun billing these codes and implemented processes to track payor response. The majority of these customers charge $0.01 for T codes to allow for tracking on payor activity. Furthermore, while a $.01 payment or denial will have minimal impact on finances, visibility into adjudication outcomes by payor does allow pathology practices to monitor trends, while the payors subsequently collect data, which is the intended purpose of Category lll codes.

Keep in mind the intended purpose of providers billing Category lll codes is to facilitate data collection not reimbursement. Until there is clear established reimbursement guidance from payors regarding digital pathology codes, there is always the potential for payors to determine that payment was made in error and seek recoupment.

Pathway to Reimbursement

Irrespective of the reimbursement amount, the percentage of T codes receiving payment sparks further interest in the potential emergence of payer policies and a potential perceived value for digital pathology.

For pathology practices, here are the reasons to report these codes, when applicable, despite the absence of immediate reimbursement:

• Data Collection and Analysis: Reporting digital pathology codes facilitates the collection of data and the generation of statistics related to the adoption and utilization of digital pathology technology. This data can prove invaluable for research, quality improvement initiatives, and healthcare policy decisions.
• Advocacy and Policy Influence: By reporting on digital pathology codes, pathology practices can underscore the value and significance of digital pathology in enhancing patient care, reducing errors, and increasing efficiency. This information can be leveraged to advocate for policy changes that may ultimately lead to reimbursement in the future.
• Future Reimbursement Opportunities: Reporting on digital pathology services establishes a historical record and a compelling case for potential reimbursement down the road as payers and policymakers become more familiar with the technology and its benefits.
• Support for Transition to Category 1 CPT Status: Category 1 CPT codes are for services performed by many physicians in multiple locations. The transition to Category 1 necessitates the thorough establishment and documentation of clinical effectiveness through peer-reviewed literature in the United States.

In summary, the consistent reporting of digital pathology codes is vital for building a strong case for their transition from Category III to Category I codes. This transition can lead to broader acceptance, improved reimbursement, and better integration of digital pathology services into routine clinical practice. It ultimately benefits both healthcare providers and patients by advancing the use of innovative technologies in medicine.

For more information on billing digital pathology codes, contact us.