Wiki Flows and bone marrows - Attention Pathology coders

ELIMGUZ55

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Attention Pathology coders!

Our billing office is getting an unusual amount of Denials from Medicare when we bill for Cytopahology ;

Flow cytometry = 88187 - 88189 and Bone Marrow =88305

the NCCI policy manual stated this:


3. Medicare does not pay for duplicate testing. Immunocytochemistry (e.g., 88342, 88360, 88361) and flow cytometry (e.g., 88184-88189) should not in general be reported for the same or similar specimens. The diagnosis should be established using one of these methods. The physician may report both CPT codes if both methods are required because the initial method does not explain all the light microscopic findings. The physician may report both methods utilizing modifier 59 and document the need for both methods in the medical record.
If the abnormal cells in two or more specimens are morphologically similar and testing on one specimen by one method (88342 or 88184, 88187, 88188, 88189) establishes the diagnosis, the same or other method should not be reported on the same or similar specimen. Similar specimens would include, but are not limited to:
(1) blood and bone marrow;
(2) bone marrow aspiration and bone marrow biopsy;
(3) two separate lymph nodes; or
(4) lymph node and other tissue with lymphoid infiltrate.

we are billilng the immunohistochemical stains done on the Bone marrows with the 59 modifier, however, Medicare and other payer's with Medicare products are DENYING the 88305 (Bone marrow) as a bundled service. I have been coding Pathology for the last 10 years and don't remember this ever happening prior to Jan. 1st. 2013 when this policy revision went into effect.

Is anyone else haveing this problem? How are you addressing the issue? any feed back will help. thanks
 
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