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Sickness billing format for client for Security

so we have some of the current Category 3 digital pathology codes list here with their Associated procedures and these are relatively new codes in 2023 the AMA released new digital pathology CPT codes developed by cap um these codes are designed to report the additional clinical staff work and service requirements associated with digitizing glass microscope slides for primary diagnosis so in 2023 13 add-on codes were introduced and in 2024 30 new add-on codes were released uh the future outlook it doesn't seem that there are any new Category 3 codes specifically announced for digital pathology so I think we have everything we need here on this current screen we're going to go ahead and flip to the Category 3 code reimbursement that we're seeing here um right now Medicare doesn't assign rvu to Category 3 codes rendering them nonp payable we do however know that some Macs have the discretion to determine allowable payments for these codes on a Case by casee basis what we are seeing is some commercial payers are reimbursing the Category 3 codes we have some po HMO Indemnity plans with Blue Cross Blue Shield ARP UMR Etna Physician Mutual and more and then we are also seeing some Medicare and Medicaid managed cares go through UHC and allow payments for these services and typically what we are seeing is an average payment between 20 and $35 when these are allowed some things that you should be thinking about um with seeing these payments from some of these commercial payers is how are you currently assigning a fee for service we have seen um clients prices at you know a cent to ensure they pass through Clearing House edits that's a similar approach that was used during the pqrs days and then we're also seeing some clients determine the price based on the actual cost incurred for the service provided so this would be a good time to align um your fee for service to ensure accurate reimbursement and reflect the TR value of services provided we recommend to assign fees for Category 3 digital pathology based on the actual cost incurred this approach not only aligns with the true expense of digitizing glass microscopic slides but also prepares your practice for a smoother transition if these codes are upgraded to category one in the future by doing so you can avoid the need for significant adjustments later Ure and ensure consistent and fair compensation from payers um as you know each payer has unique policies for reimbursing Category 3 codes and it's important to check with each payer to determine if they indeed cover these services and what specific conditions they may require let's see um we have some category we'll move on to the proper Category 3 code utilization and compliance um as for as far as documentation we want to ensure that the path pathology report specifies that the case was read digitally and includes the name of the system used with that being said you also want to um make sure the documentation includes the address of the location where the interpreting pathologist read the slides also it's important to note that all slides on a report may not have been read digitally so we want to ensure that the pathology report format can differentiate between digitized slides in slide analysis and microscopic slide analysis that's something to consider the application for Category 3 code should be applied to the technical component only for digital pathology however in 2024 we did see some additional codes such as peripheral blood smears that do not have a separate tcpc component so in those cases The Entity that prepares the digitized slide image or performs that digiti digitization procedure May report the applicable add-on Category 3 code so that's important to note um there's a handful that don't have that uh TC or that TC component currently um pairing with primary codes Category 3 codes must be reported alongside the primary CPT code these add-on codes are built as a one to one unit of service with the primary procedure code so we have an example if you are digitizing slides for a surgical path pathology procedure you would report the appropriate category 3 code add-on code for each primary procedure surgical procedure performed as we're all aware both mcci and mu edits are updated quarterly so it's important to stay current with those updates to to ensure compliance um I don't foresee any changes in that and then regular updates you want to stay informed about updates Category 3 codes as they're temporary and subject to change there are some um there's information basically after five years the AMA will either convert that category three charge to a category one code and that's what we're hoping for but you know we're still unclear if that's going to happen