Wiki Consult help - 88325?

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aleigh

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Hello, I have a question regarding 88325 and if this situation would warrant that CPT. We have an orthopedic surgeon not wanting to send the femoral head to pathology. Apparently in our state it is on the exempt list of specimens that have to be sent to pathology. For QA purposes, the pathologist is at least wanting to review the patient's imaging studies. Would an 88325 be appropriate? He would be reviewing and creating a report of the reviewed material, but there would be no slides in this case. That is why I am questioning this code and hoping there is a more appropriate possible E/M code out there. Thanks in advance!
 
Thank you. Do you know of any other consult code for medical record review? I've looked into the review of patient records but they all seem to have a face to face component with the patient. So I don't think they would be applicable.
 
You're correct, E/M or consultation services require a face-to-face service, there isn't an equivalent code for medical record review.

In addition, you mention that this is being done for QA purposes and not as a component of the patient's treatment plan since pathology was not requested by the physician, so that would exclude the service from coverage under Medicare and most private payers. Medicare coverage guidelines require that all non-preventive services be medically necessary and incident to a physician's service. Similarly, consider that laboratories or diagnostic testing facilities would not bill patients' plans for quality assurance measures or validation procedures done as a part of the operation of the lab and not requested by the treating physician as part of the plan of care.
 
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