janeefox
New
I have a client that wants me to code 88342 more than once on the same specimen and it is the same stain. Here is what she is wanting...
I had called you because the CMS has published new unit of service rules for special stains, including 88342 and 88360 effective 10/01/09, as you see, the unit of service for special stains will be the BLOCK, not the SPECIMEN, so we can bill per stained BLOCK. For example, cytokeratin on 4 blocks would be 88342x4 not 1. I had asked you to look at Chapter 10 Version 15.3 NCCL manual, which you responded below. I disagree. I am copying page 15 of the manual below. Please take a look and pull some examples like we talked about yesterday to ensure that we are billing by block not by specimen.
Page 15 10/01/09 NCCL update 2010 Chapter 10...
8. The unit of service for special stains (CPT codes 88312-88313) and immunohistochemistry (CPT codes 88342, 88360, 88361) is each stain. If it is medically reasonable and necessary to perform the same stain on more than one specimen or more than one block of tissue from the same specimen, additional units of service may be reported for the additional specimen(s) or block(s). Physicians should not report more than one unit of service for a stain performed on a single tissue block. For example it is common practice to cut multiple levels from a tissue block and stain each level with the same stain. The multiple levels from the same block of tissue stained with the same stain should not be reported as additional units of service. Only one unit of service should be reported for the stain on multiple levels from the single tissue block. Additionally, controls performed with special stains should not be reported as separate units of service for the stain.
I am trying to get the right answer on this one...can anyone help me? My understanding is only 1 stain of same type per specimen.
I had called you because the CMS has published new unit of service rules for special stains, including 88342 and 88360 effective 10/01/09, as you see, the unit of service for special stains will be the BLOCK, not the SPECIMEN, so we can bill per stained BLOCK. For example, cytokeratin on 4 blocks would be 88342x4 not 1. I had asked you to look at Chapter 10 Version 15.3 NCCL manual, which you responded below. I disagree. I am copying page 15 of the manual below. Please take a look and pull some examples like we talked about yesterday to ensure that we are billing by block not by specimen.
Page 15 10/01/09 NCCL update 2010 Chapter 10...
8. The unit of service for special stains (CPT codes 88312-88313) and immunohistochemistry (CPT codes 88342, 88360, 88361) is each stain. If it is medically reasonable and necessary to perform the same stain on more than one specimen or more than one block of tissue from the same specimen, additional units of service may be reported for the additional specimen(s) or block(s). Physicians should not report more than one unit of service for a stain performed on a single tissue block. For example it is common practice to cut multiple levels from a tissue block and stain each level with the same stain. The multiple levels from the same block of tissue stained with the same stain should not be reported as additional units of service. Only one unit of service should be reported for the stain on multiple levels from the single tissue block. Additionally, controls performed with special stains should not be reported as separate units of service for the stain.
I am trying to get the right answer on this one...can anyone help me? My understanding is only 1 stain of same type per specimen.