Wiki cpt code 88172

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punkyboo

punkyboo

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I am at my wit's end with this.
We are billing with cpt code 88172 (Cytopathology, evaluation of fine needle aspirate) for 4 units, because the evaluation was done on 4 different specimens.
An Anthem rep told me they only pay $52 for a total of 1 unit. Curious, I called Medicare to see how if they allow for billing of units...and was told yes, but 4 units is too many! And of course, she could not tell me the max number that can be billed.
She did direct me to the Medically Unlikely Edits on www.cms.hhs.gov, but all I can is an Excel spreadsheet with 2 columns...the first has the hcpcs/cpt code, the other has the Medically Unlikely Edits and there is a single number after each hcpcs/cpt code.
Am I missing something here? All I wanted to know was how many units I could bill for cpt code 88172 :confused:

Anybody have any ideas, on the original question, or even how to read the Medically Unlikely Units spreadsheet???

Thanks,
Kat
 
I'd appeal w/ documentation

NOT my area of expertise, but ...

I'd appeal with documentation that clearly shows four unique specimens.


F Tessa Bartels, CPC, CEMC
 
Last edited:
88172 - multiple units

Just to verify - are you including a modifier -59 on the code to indicate separate specimens? If not, that may be why the bill is being rejected.
 
88172

this can be billed once per specimen so yes you should get paid for 4. we always appeal with records when ours deny. But in response to your other question to read the medically unlikely edits, the 2 columns are , one the cpt/hcpcs code, and the second column is the # of units billable , any more than that and they deny as to many units billed, but if you appeal you will most likely get paid.

path supervisor
 
can i bill 88172 with cpt 55700 (prostate needle biopsy) and is it payable?
thanks
 
It is my understanding you should only bill 88172 if 10021 or 10022 was performed.
 
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