Summary
Q. as long as digitization of glass slides occurs in the technical component (TC) process, regardless of whether or not the digitization of glass slides and pathologist review are performed remotely? Is a lab in compliance to bill the digital codes if a pathologist sits in the office next to the lab?
Q. Do regulatory agencies still support sodium citrate platelet counts? What is the CAP’s standing?
Q. Is secretory change in endometrial hyperplasia acceptable in the absence of progestin therapy? What is the appropriate way to address an endometrial biopsy with secretory glandular changes and an increase in the gland-to-stroma ratio?
Editors: Olga Pozdnyakova, MD, PhD, Geoffrey Wool, MD, PhD, David Bernard, MD, PhD & Raul S. Gonzalez, MD
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Q. Can digital pathology codes be billed as long as digitization of glass slides occurs in the technical component (TC) process, regardless of whether or not the digitization of glass slides and pathologist review are performed remotely? Is a lab in compliance to bill the digital codes if a pathologist sits in the office next to the lab?
A. April 2026—Category III digital pathology codes may be used when a glass microscope slide is digitized, either by whole slide imaging or live-view whole slide imaging, and the pathologist interprets the slide digitally to arrive at an interpretation for primary diagnosis. To report these category III add-on codes, the pathologist may view the images within a hospital or other site that has a CLIA license or interpret the slide remotely provided all Centers for Medicare and Medicaid Services requirements for remote interpretation are met.
Category III add-on codes (CPT 0751T–0763T, 0827T–0856T) are intended to capture the additional practice expense associated with the technical component of glass microscope slide digitization, when reported in an appropriate clinical context and as part of a clinical service to an individual patient. When use by a pathologist in primary diagnosis is documented, the laboratory performing or purchasing the glass microscope slide digitization may report these category III add-on codes, either in conjunction with the specific allowable category I base code pathology service (billed globally) or as TC only (based on laboratory type). Each category III add-on code is reported as a one-to-one unit of service for each primary pathology service code.
Ronald W. McLawhon, MD, PhD
Chair, CAP Economic Affairs Committee
Division of Laboratory and Genomic Medicine
Department of Pathology
University of California San Diego
La Jolla, Calif.
Q. Do regulatory agencies still support sodium citrate platelet counts? What is the CAP’s standing?
A.Sodium citrate platelet counts are not banned by the CAP, CLIA, or the FDA. However, because most automated hematology analyzers are FDA cleared only for EDTA-anticoagulated whole blood, running citrate samples is considered a modified method/laboratory-developed test (LDT). Under CLIA, running platelet counts on citrate samples outside the FDA-cleared intended use requires full validation of accuracy, precision, reportable range, reference interval, and citrate correction factor before the method can be used clinically.