Microscopic Precision for
Pathology Practices
Pathology billing is a high-volume, high-complexity environment. From correctly splitting Professional (26) and Technical (TC) components to mastering IHC and flow cytometry codes, we ensure your diagnostic expertise is fully compensated.
Modifier 26 Mastery
We flawlessly navigate the complexities of global billing versus splitting the Professional Component (26) and Technical Component (TC) based on the place of service.
Why Pathology Demands Specialized Billers
Pathologists deal with massive daily case volumes with relatively low per-claim dollar amounts. A generic billing setup will fail to catch bundled IHC stains, incorrect surgical pathology levels, or mismatched accession numbers. We build an automated, high-precision revenue cycle to capture every micro-claim.
PC/TC Component Splitting
Depending on whether you own the lab equipment or just read the slides at a hospital, we accurately apply Modifier 26 (Professional) or TC (Technical) to ensure compliant billing.
Surgical Pathology Levels
We map every tissue specimen to its correct level (88300-88309). Our team audits gross descriptions to prevent under-coding complex resections or over-coding simple biopsies.
IHC & Flow Cytometry
Special stains, Immunohistochemistry (IHC), and flow cytometry require exact unit counts and primary/secondary antibody distinctions. We ensure you are paid for every single marker tested.
Securing Revenue from
Specimen to Final Report
We seamlessly integrate with your Laboratory Information System (LIS) to scrub, sequence, and submit claims faster, ensuring zero data loss between the lab and the payer.
LIS Data Extraction
We interface directly with your Laboratory Information System (LIS) to pull accession numbers, demographic data, and the referring provider’s NPI without manual data entry errors.
Specimen Level Coding
Our certified coders review the pathology report to assign the correct CPT for the gross and microscopic examination, ensuring it matches the specific anatomical site.
MUE & NCCI Scrubbing
Claims pass through Medically Unlikely Edits (MUE) scrubbers to ensure unit counts (e.g., number of blocks or stains) do not exceed payer limits, preventing instant denials.
Micro-Denial Management
Pathology claims are often low-dollar but high-volume. We deploy automated appeal systems to efficiently recover funds for "inclusive" or "not medically necessary" denials.
Stop Losing Money on
High-Volume Claim Denials
Partner with certified pathology billers who understand LIS integration, PC/TC splits, and complex surgical pathology coding. Contact Valeria Healthcare Solutions today.