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Pathology/Lab Coding Alert

Reader Question:

88321 Boasts Special Medicare Restriction

Published on Mon Aug 08, 2011

Question: Our pathologist received a request for a consultation on slides from an outside lab. The submission included breast tissue and lymph node slides from a mastectomy dated March 16, 2008 and slides from a lung biopsy dated May 12, 2011. The patient is a Medicare beneficiary. I know that CMS has an MUE of one for 88321, but can we use a modifier and report 88321 x 2?Illinois SubscriberAnswer: For a Medicare beneficiary, you should report only 88321 (Consultation and report on referred slides prepared elsewhere) for this case. You should not list multiple units of the code, even though the referral involved two accessions from two different surgical sessions.You are correct that CMS has a limit of one unit of 88321 in its Medically Unlikely Edits (MUEs). Further, you're correct that you can override the MUE limits by using a modifier, in some cases.Why only one 88321? Medicare [...]
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