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83912

kleymeer

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In our lab we are doing mutation studies for MTHFR677 AND MTHFR1298 by pcr. We code 83890 molecular diagnostics-molecular isolation or extraction, 83900 amplification target-multiplex first two nucleic acid seq., 83892 x2 enzymatic digestion, 83896 x4 nucleic acid probe, 83914 mutation identification by enzymatic ligation or primer extension, single segment, each segment and 83912 interpretation and report. The question I have is that the Lab Director is doing an interpretation for each mutation but is writing only one report so should we be billing one unit or two for 83912. Also, about 25% of the time only one mutation test is ordered so in that case it is clear that only one unit should be billed. It is when both mutation tests are ordered that it becomes confusing? Any thoughts on what is correct?
 

mannlx

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per the new medicare standards 83912 can only be billed once per day, regardless of # of tests or specimens performed
 

mannlx

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I have been coding as one 83912 if there are 2 test on the same target, but if there are two different targets, then I bill for 2 units of 83912. What does everyone else think??

for example I would bill 2 units of 83912 on this because test were done on specimen one (part 1) and specimen two (part 2):

Molecular Anatomic Pathology Testing:
Part 1:
A. Mutations in BRAF, NRAS61, HRAS61, KRAS12/13, and RET/PTC1,
RET/PTC3 and PAX8/PPARg rearrangements NOT IDENTIFIED.

Part 2:
A. Mutations in BRAF, NRAS61, HRAS61, KRAS12/13, and RET/PTC1,
RET/PTC3 and PAX8/PPARg rearrangements NOT IDENTIFIED.



thanks,
Lisa
 
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I bill two units of 83912 only when two different tests are being interpreted: ie two different 'panels' for individual mutations. A panel for two mutations in the same test (EGFR/KRAS) would only generate one interp charge. Doing EGFR and then later a KRAS based on those results would generate two interp charges.

The Part 1, Part 2 example is probably okay if the tests were done on two different tumors but it looks like duplicate testing to me without any other information.

Medicare does allow only one unit per day regardless of how many possible mutations are evaluated.
 
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