Question Billing radiology charge with pathology charges

danachock

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Hi, Good Evening,
I have a quick question I would like to ask please. I am performing analysis on pathology charges that is billing 76098 (radiological examination of surgical specimen) just billing the professional charge only that I am not acclimated seeing being billed together with pathology charges. But reviewing the pathology report it is the pathologist that is actually billing the procedure 76098 for this interpretation that is recorded in the pathology report; I don't believe they are reading a radiology report and just reiterating information and that the pathologist is actually performing the radiology interpretation not a radiologist. Maybe they are credentialed (multi-specialty) to bill this procedure? But I am just curious, is this a normal practice for any other facilities out there?
Thank you in advance for your expertise and any insight you may provide and have a wonderful evening,
Dana
 
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Hi Dana,
Code 76098 - Radiological examination, surgical specimen
Our pathologists often use this code when reviewing an x-ray to verify the orientation of the specimen or to confirm the precise location of anomalies within the specimen (like calcification deposit or lesion) so that they can properly section levels for microscopic evaluation. I see it most often used with breast cases (usually needle localized - but also core biopsies).
Paget's and CAP both stress that it's important (obviously) that it documented properly on the report for accurate code determination and audit support. I believe that several of our pathologists have created macros for dictation for when they review an e-ray and we bill 76098.

The APF Pathology Handbook (Paget's) has a nice explanation on page 335 of the latest edition, that you may find helpful too. They verify that this code is an accurate depiction of what a pathologist might do in respect to breast specimens.

Dana - I count on your expertise throughout the threads on this forum and I credit so much of my pathology coding knowledge to you (even when it is give to other people and accessed via this forum). Although I have been coding pathology for a couple of years, I still feel often like a novice. Resources can feel few and far between, and sometimes a quick search of the forum has helped me tremendously. I find your responses among the most concise and helpful. Striving in my own evolution as a coder, you are a "pseudo-mentor" to me. I never dreamed I might be able to assist you, so I hope that you find this response helpful.

In kind,
Laurie Easton, CPC, CPB
 
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danachock

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Hi LaurieAnn22, (Laurie)
Your very kind words mean the world to me! I so do appreciate you giving me insight on the 76098 today. Yes, the majority of the cases I have reviewed are breast related. I am again so honored by your kind words. I know life is incredibly busy for everyone, but I try to dedicate time to help on the AAPC forums. I was a self-taught pathology coder (no actual pathology resources (like the APF manual)] except the NCCI manual I downloaded every year along with questions I provided my pathology team for assistance along with my exhaustive research on the internet. Pathology coding can in a "sense be a beast" and if I can help, I always want to jump in when able to help. I only want to help and assist when I can with coding pathology, I simply do not have all the answers.
You are probably an awesome pathology coder and conquering huge hurdles in the pathology coding industry! I'd love an opportunity to review your pathology cases. Please do not be discouraged. Write down your questions on a note pad and either try to research them online or ask your pathologist's their opinion or even your colleagues. From my experience, the pathologists really don't care that you have a question. Just send them a query or email (unsure how your facility communicates). They are super eager and elated to have a discussion (that may be long winded - just be forewarned, okay??).
Give them your explanation on why the CPT assignment possibly was incorrect and provide a small snip from your pathology manual on why you felt it was possibly inaccurate. I had one very recently that was horribly wrong not long ago that I wanted to share okay. It was a solid omentectomy that turned out to be a desmoid fibromatosis. After the fact, I found out it was accessioned 88305 for biopsy and it was clearly resection for tumor which should be 88309. Yes, I simply could have corrected the charge and not said anything to anyone, and life would have been good. But instead, I kindly reached out to our pathologist personally and explained the scenario with facts. They did kindly reply that they agreed with MY correction I had made and apologized for them, as the pathologist not correcting 88305 to 88309 during their coding accession.
I feel like I could sit here and tell your stories all night long, but it is late.
Thank you again for being so kind. I so do appreciate your insight with something new with coding radiology with pathology here. I haven't had this opportunity before but appreciate your expertise.
Have a wonderful evening!
Dana
 
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