Advanced Search

Pathology/Lab Coding Alert

You Be the Coder:

88363 Won't Take Modifiers 26, TC

Published on Sun Jan 09, 2011

Question: Is new code 88363 for a technical or professional service?Answer: Code 88363 (Examination and selection of retrieved archival [i.e., previously diagnosed] tissue[s] for molecular analysis [e.g., KRAS mutational analysis]) describes both a technical and a professional service.CPT 2011 introduces 88363 "to accurately report the pathologist's identification and selection of appropriate tumor tissue from previous surgical specimen..." according to CPT Changes 2011: An Insider's View -- clearly describing a professional service. The document goes on to state that the pathologist's tissue identification and selection are critical to the success of the molecular diagnostics test that is to follow.Look to fees: The Medicare Physician Fee Schedule does not allow technical component (TC) or professional component (26) modifiers with the 88363. However, it does provide a higher payment rate for non-facility versus facility -- and that difference comprises the technical component of the service, such as sectioning blocks selected by the pathologist for molecular [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Pathology/Lab Coding Alert

View All