How is specimen-level billing handled?

Each specimen is captured as a distinct billable unit with its correct level code, and additional blocks, stains and studies are captured against the case, so multi-specimen cases are billed completely rather than as a single unit.

Do you support client billing?

Yes. Cases are routed automatically to client billing or insurance billing based on referral source and contract terms, with client fee schedules, statements and receivables managed separately.

How do you address medical necessity denials?

Claims are screened against applicable LCD and NCD policies before submission, and cases lacking a supporting diagnosis are flagged for review or ABN workflow rather than submitted into a predictable denial.

Pathology

Healthcare IT and billing built for a pathology practice

Specimen-level billing, CLIA compliance and client billing workflows for pathology and laboratory groups.

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Why pathology is different

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Pathology billing operates at the specimen level, where a single case may generate multiple units, special stains and consultations: each with distinct codes and medical necessity requirements.

Healthcare SBC manages specimen-level charge capture, unit-based coding, client versus insurance billing determination, and the medical necessity edits that lab claims depend on.

Common challenges

Where pathology practices lose revenue

The billing and workflow problems specific to this specialty, and the ones generic systems handle badly.

Specimen-level unit coding

Multiple specimens and blocks per case require accurate unit counting that manual processes routinely miss.

Client versus insurance billing

Deciding which party is billed for each case depends on referral source and contract terms.

Medical necessity edits

Lab claims face aggressive LCD and NCD medical necessity screening that denies unsupported tests.

Special stains and ancillary studies

Immunohistochemistry and molecular studies carry their own coding and documentation requirements.

How we address it

Built for pathology workflows

Specimen-level charge capture with accurate unit determination
Automated client versus insurance billing routing by referral source
Medical necessity screening against LCD and NCD policies
Special stain, IHC and molecular study coding support
Client contract, fee schedule and statement management

Commonly billed codes in pathology

A sample of the codes our pathology coders work with daily.

88305Surgical pathology, gross and microscopic, level IV
88307Surgical pathology, gross and microscopic, level V
88312Special stain including interpretation, group I
88341Immunohistochemistry, each additional antibody
88175Cytopathology, cervical or vaginal, with screening

Codes shown for reference only. Verify against current code sets and payer policy.

Other diagnostic specialties

Radiology

Professional and technical component billing, high-volume claim throughput and imaging authorization for radiology groups.

FAQ

Pathology, frequently asked questions questions

How is specimen-level billing handled?: Each specimen is captured as a distinct billable unit with its correct level code, and additional blocks, stains and studies are captured against the case, so multi-specimen cases are billed completely rather than as a single unit.
Do you support client billing?: Yes. Cases are routed automatically to client billing or insurance billing based on referral source and contract terms, with client fee schedules, statements and receivables managed separately.
How do you address medical necessity denials?: Claims are screened against applicable LCD and NCD policies before submission, and cases lacking a supporting diagnosis are flagged for review or ABN workflow rather than submitted into a predictable denial.

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