Wiki Billing in Units for Medicare

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Kevinph84

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My Fellow Coders,

I'm on the hunt for information about billing in units for Medicare. Does anybody have any information pertaining to billing in units? I've currently exhausted all of my leads.

For example:

The pathologist charges 88305 for three different specimens. Being three different specimens, can you bill in units?

Thank You,
Kevin
 
Each specimen is serately billable.

Per CPT, a specimen is any tissue or tissues submitted for individual and separate exam and diagnosis. If the pathologist was given three separate specimens and he/she did a gross and micro exam on all three and diagnosed them separately, you bill 88305 x3 (assuming they are Level IV exams, of course).
 
Kevin,
I been doing Pathology billing for years and have always billed in unit form to Medicare and all other carriers. Billing one unit on each line will lead to denials, because Medicare and everyone else will think that these are duplicate specimens. I have only run into one code 83912 that can't be billed in unit form to Medicare. I looks like your in FL like myself and the same rules would apply. As for actual info from Medicare on billing in unit form; I don't have any. But if you follow my advise you should have no problems. :cool:

Thomas
 
Regarding MUE...

I've been down this road before with CMS/MUE.
You open up an Excel spreadsheet with cpt codes, and a 1,2 or 3 next to them. It doesn't tell you anything about any edits!
Where do you find the actual wording of the edits?
I've been tearing my hair out trying to figure this out!

~Kat
 
Kevin,

When it is medically necessary to evaluate both bone structure and bone marrow, and both services can be provided with one biopsy, only one code (CPT code 38221 or CPT code 20220) can be reported. If two separate biopsies are necessary, then both can be reported using modifier -59 on one of the codes. Pathological interpretation codes 88300-88309 may be separately reported for multiple separately submitted specimens. If only one specimen is submitted, only one code can be reported regardless of whether the report includes evaluation of both bone structure and bone marrow morphology or not.

http://www.cms.hhs.gov/NationalCorrectCodInitEd/01_overview.asp#TopOfPage

Look under NCCI Policy Manual and then click on the first PDF
 
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