76098 Radiological examination, surgical specimen

bbooks

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My pathologists would like to start charging for when they review the mammogram that comes with needle localization excisions. I've read the rules and restrictions but would like another opinion on whether this documentation proposed by the pathologist should be sufficient. I think it is, but would like another opinion before we proceed.

This would be added to the gross: "The accompanying x-ray was reviewed by the pathologist to confirm the lesion’s location, 6 margins are inked. The lesion and margins are submitted for microscopic examination."

Padget has a section on this topic, and there is also information found here:
http://apsmedbill.com/whitepapers/cpt-code-76098-radiological-examination-surgical-specimen
http://www.captodayonline.com/Archives/feature_stories/0603CPTqa.html
https://www.supercoder.com/my-ask-an-expert/topic/76098-2

Thanks much!
 

CodingKing

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This code is for intraoperative radiological exam. If this is a referred specimen and not done while the patient is in surgery, you cannot bill this. If this was done during the surgery with advise to physician as to whether the whole thing was removed then you can bill for it.
 

bbooks

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Interesting. I don't see any documentation with the code description that it needs to be done intraoperatively, and Padget does not mention this either.
 

CodingKing

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I hope i'm interpreting it My CPT layman's description book correctly. It states that the study uses x-ray to examine a tissue specimen looking for evidence the surgeon removed the entire lesion. Radiologist confirms that the appropriate area is excused by evaluating the margins to determine they are all clear. Radiologist immediately reports the findings to the surgeon to complete the procedure. A pathologist may also review the film to determine the best positioning of the specimen and are to section to ensure the most appropriate part of the specimen is cut for microscopic examination and diagnosis.

Now I'm confused if its to be billed by the radiologist and the pathologist?
 

bbooks

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"A pathologist may also review the film to determine the best positioning of the specimen and are to section to ensure the most appropriate part of the specimen is cut for microscopic examination and diagnosis." This would be done while the pathologist is grossing the specimen.

The professional component (26 modifier) can potentially be charged by both the radiologist and the pathologist. Some insurance will not allow multiple charges of 76098 (Medicare included). I also read that the pathologist should submit the charge also with the 77 modifier: repeat procedure or service by another physician or other qualified health care professional.

Documentation must include that the x-ray was reviewed by the pathologist, the objective of the review, and the action take. Thus, my question to confirm if the documentation that our pathologist proposes would be sufficient.
 

irishhawk

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Glad to find this thread, I have the same question! Although in our practice, I'm advocating for using this code; two of my pathologists say we cannot use it. I have put the question out to the "coding expert" in our billing company and will post her take when she returns my message.

Update: my experienced source at our billing company writes (citing the CAP reference, see above link) that pathologists CAN report the code, provided the documentation is complete; however, most payers only reimburse 1 unit of 76098 per DOS. She goes on to say that most of their clients (the pathologists) don't want to cause any trouble with referring physicians, so they choose to leave this charge off - rather than get into a "I billed this first!" contest.

So perhaps that leaves a window open in that the DOS a pathologist used to examine the films could be different than the DOS used by the radiologist or other clinician. Hmmm.
 
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