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Wiki 88313
- Thread starter tuchito5
- Start date
danachock
Expert
TThivierge
True Blue
Hi Tuchito,
From reading the CPT manual it seems this lab stain process can be used on biopsy taken from more than once but on differ organs. Organ listed are colon, bladder, tongue, testis, bone breast. if the pt had problem with each area and provider wanted to do the stain of CPT 88311, then CPT 88312+. The CPT 88312 takes on special stain plus interpretation on each bx block. CPT 88313 is other type of stain used. If it is medical justified Medicare should not deny it.
Well that is my 2 cents on the matter.
Lady T
From reading the CPT manual it seems this lab stain process can be used on biopsy taken from more than once but on differ organs. Organ listed are colon, bladder, tongue, testis, bone breast. if the pt had problem with each area and provider wanted to do the stain of CPT 88311, then CPT 88312+. The CPT 88312 takes on special stain plus interpretation on each bx block. CPT 88313 is other type of stain used. If it is medical justified Medicare should not deny it.
Well that is my 2 cents on the matter.
Lady T
TThivierge
True Blue
Danachok
I took information out of the CPT manual. I did not make anything up. I was just trying to help.
Lady T
I took information out of the CPT manual. I did not make anything up. I was just trying to help.
Lady T
Narobo
Contributor
I've never heard of a yearly limit for either of these special stains. There is a daily limit regarding the DOS associated. Are you coming across a lot of denials regarding the CPT's?
danachock
Expert
Hi nkovar,
No, I haven't seen any rash of denials with either CPT codes (88312 or 88313) and I have never heard of a yearly limit for either special stain (88312 or 88313).
Okay no worries, you received a denial from your comment above. What charges (CPTs) were billed and what did the denial state? I am betting that it was the benefit maximum for this time period or occurrence had been reached. That can be based on two types of scenarios (maximum $$ [dollar amount] allowed was exhausted OR the maximum number of visits was exhausted). Does the EOB allow you to NRP (next responsible party) those charges to the patient? Or is it possible the patient has secondary insurance that those charges should be forwarded to?? If the patient has Medicare, are you able to check their EHR (electronic health record) to see if they signed off with an ABN (Advance Beneficiary Note of Non-coverage)?
Hopefully, I provided something you can lean on working this denial.
Please reach out if you need anything else okay.
Dana
No, I haven't seen any rash of denials with either CPT codes (88312 or 88313) and I have never heard of a yearly limit for either special stain (88312 or 88313).
Okay no worries, you received a denial from your comment above. What charges (CPTs) were billed and what did the denial state? I am betting that it was the benefit maximum for this time period or occurrence had been reached. That can be based on two types of scenarios (maximum $$ [dollar amount] allowed was exhausted OR the maximum number of visits was exhausted). Does the EOB allow you to NRP (next responsible party) those charges to the patient? Or is it possible the patient has secondary insurance that those charges should be forwarded to?? If the patient has Medicare, are you able to check their EHR (electronic health record) to see if they signed off with an ABN (Advance Beneficiary Note of Non-coverage)?
Hopefully, I provided something you can lean on working this denial.
Please reach out if you need anything else okay.
Dana