AMA Adopts More Digital Pathology Category III Codes for 2024

On June 30, 2023, the CPT Editorial Panel published additional Category III codes to monitor the expanded use of the digitization of pathologic microscopic slides. The new codes are in addition to the thirteen (13) category III digital pathology codes adopted for use January 1, 2024 and are used to capture the technological cost and clinical staff time associated with producing and maintaining whole-slide images.

The AMA is also clarifying the guidelines associated with the use of the digital pathology codes stating, “Static digital photographic and photomicrographic imaging or digital video streaming of any portion of a glass microscope slide on mobile smartphone and tablet devices does not constitute a digital pathology procedure.” Rather, these “add-on” category III codes +0751T-+0763T and +0827T-+0856T are used when whole slide images are captured and used for examination and formulation of a primary diagnosis.

As a reminder, add-on codes must be accompanied by a primary Category I CPT code with each Category III code reported in a one-to-one unit of service with the primary service code (e.g., 88331×2 add on 0841Tx2). Contrary to AMA, NCCI MUE (Medically Unlikely Edit) is set at “1” per date of service (MAI=2).

Pathology diagnoses formulated using digitally scanned images must include documentation within the pathology report that the case was interpreted digitally as well as the system that was used to produce the digital image(s).

Other important information about these codes:

  • Do not report these codes for images used for archival purposes, educational purposes, database creation or clinical conference presentations.

  • While payment rate has been adopted by CMS, some private payers may award payment when reported with primary pathologic services.

  • Category III codes are temporary codes designed to track the use of emerging technology, services, or procedures in efforts to access the widespread adoption of use of the service.

The new codes are effective for use as of January 1, 2024 and should be listed separately in addition to code for the primary procedure.

Source: AMA Website

This educational guide was prepared as a tool to provide education for documentation and coding. It is not intended to affect clinical treatment patterns. The material provided is for informational purposes only. Efforts have been made to ensure the information within this document was accurate on the date of distribution. Reimbursement policies vary from insurer to insurer and the policies of the same payer may vary within different U.S. regions. All policies should be verified to ensure compliance. CPT® codes, descriptions and other data are copyright of the American Medical Association (or such other date of publication of CPT®).All Rights Reserved. CPT® is a registered trademark of the American Medical Association. Proprietary and confidential document.  All rights reserved. No part of this document may be reproduced or used in any manner without the written permission of MSN Healthcare Solutions, LLC.

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