Are you ready for the 2027 Pathology & Laboratory coding changes? Stay ahead of new codes, reporting rules, documentation requirements, and reimbursement updates that can impact your bottom line.
Molecular Tests, PLA Changes, Documentation and CLFS Risk
Pathology and laboratory coding continues to change rapidly as molecular testing, genomic analysis, infectious-disease diagnostics, algorithmic services and proprietary assays evolve.
Laboratories must determine whether a service is reported with an established Category I code, a Proprietary Laboratory Analyses code, another specialized code or an unlisted procedure. Because certain laboratory and PLA codes may follow quarterly release schedules, maintaining accurate systems requires more than a once-a-year update.
The coding transition also intersects with Medicare payment policy. CMS has proposed changes affecting Clinical Laboratory Fee Schedule data collection and reporting, along with the phase-in of payment reductions beginning in 2027. These payment-policy proposals are separate from CPT® coding changes, but together they create significant financial and operational concerns for laboratories.
Session Agenda
- Important 2027 pathology and laboratory code changes
- Molecular pathology and genomic-testing updates
- Proprietary Laboratory Analyses additions, revisions and deletions
- Coding considerations for infectious-disease testing
- Selecting between Category I, PLA and unlisted reporting pathways
- Test methodology, analyte and specimen documentation requirements
- Medical-necessity and diagnosis-support considerations
- MolDX, Medicare Administrative Contractor and payer-policy checkpoints
- Frequency limitations and coverage-related denial risks
- Maintaining code tables when quarterly laboratory updates occur
- CMS-proposed 2027 CLFS data-reporting and payment changes
- Separating correct coding from coverage and reimbursement determinations
Session Objectives
At the conclusion of this webinar, participants will be able to:
- Identify important 2027 pathology and laboratory coding developments.
- Understand coding considerations for molecular and genomic testing.
- Distinguish between Category I, PLA, specialized and unlisted laboratory codes.
- Determine when a PLA code may be appropriate for a proprietary laboratory analysis.
- Recognize circumstances requiring specialized or unlisted procedure reporting.
- Apply appropriate coding concepts to infectious-disease diagnostic services.
- Understand reporting considerations for algorithmic laboratory services.
- Identify documentation elements needed to support complex laboratory testing.
- Explain why PLA and other laboratory-code updates may require monitoring beyond the annual CPT® update.
- Understand key Clinical Laboratory Fee Schedule (CLFS) policy considerations.
Session Highlights
- 2027 Pathology & Laboratory coding updates
- Molecular and genomic testing considerations
- Infectious-disease diagnostic coding
- Algorithmic laboratory services
- PLA (Proprietary Laboratory Analyses) codes
- Category I vs. PLA vs. unlisted codes
- When specialized laboratory codes may apply
- Appropriate use of unlisted procedure reporting
- Documentation requirements for molecular and proprietary testing
- Managing quarterly PLA releases and updates
- Keeping laboratory coding systems current throughout the year
- Clinical Laboratory Fee Schedule (CLFS) considerations
Who Should Attend
This boot camp is recommended for:
- Certified professional coders
- Specialty coders and coding managers
- Medical billers and reimbursement professionals
- Revenue-cycle directors and managers
- Physicians and nonphysician practitioners
- OB-GYN and maternity-care practices
- Radiology and interventional-radiology groups
- General surgeons and surgical practices
- Pathology groups and clinical laboratories
- Hospital outpatient departments
- Ambulatory surgery centers
- Clinical documentation improvement professionals
- Compliance officers and internal auditors
- Practice managers and administrators
- Charge-capture and charge-master teams
- EHR, coding-system and workflow implementation teams
- Consultants and provider educators
At the conclusion of this webinar, participants will be able to:
- Identify important 2027 pathology and laboratory coding developments.
- Understand coding considerations for molecular and genomic testing.
- Distinguish between Category I, PLA, specialized and unlisted laboratory codes.
- Determine when a PLA code may be appropriate for a proprietary laboratory analysis.
- Recognize circumstances requiring specialized or unlisted procedure reporting.
- Apply appropriate coding concepts to infectious-disease diagnostic services.
- Understand reporting considerations for algorithmic laboratory services.
- Identify documentation elements needed to support complex laboratory testing.
- Explain why PLA and other laboratory-code updates may require monitoring beyond the annual CPT® update.
- Understand key Clinical Laboratory Fee Schedule (CLFS) policy considerations.
