Pathology billing splits along the same professional and technical line as radiology, but with an added variable: specimen count. What counts as one specimen is defined by the payer, not by how the sample arrived.
Panel rules are the other source of rework. Where a panel code exists, billing the components individually is treated as unbundling, even when each test was genuinely performed.
What trips pathology claims up
- Technical and professional components split by where the work was done
- Panel codes billed instead of components where the panel exists
- Specimen counts billed per block or per site as the payer defines it
- Reference lab work separated from in-house so it bills to the right party
What we check before a claim goes out
- Technical and professional components split by where work was done
- Panel codes billed instead of components where a panel exists
- Specimen counts billed per block or site as the payer defines