Wiki Help Coding and Billing for Pathology

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kmweigant

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I have used 51 modifier on a few accounts. I am seeing denials from Medicare. For ‘Missing/incomplete/invalid HCPCS’. Several claims rejected for the same reason. I am stumped since we billed with the XE modifier for separate service from the hospital. How would you like us to work these?
We are an Independent Lab and we are having denials from MCR on claims with CPTs: 88361, or 88344, or 33842, or 88341; in-particular combinations of 88341/88342 we have tried 59, and XU and they remain to be denied. Suggestions would be appreciated. We are stumped.

Would love to also get more information on reading, conversations, etc. on education to help code and bill Pathology.

Would also like some refresher on how to find NCCI and Local CCI for MCR. Not sure, has been a long time since I have used the website......... DO not remember website.

Thank you for your help,
Kathy
 
Hello kmweigant,
I clearly feel your pain. Modifier 51 isn't meant for pathology.
You code everything correctly. You correct invoices to try something else and still no freaking relief. There is a line in the sand where you have to just stop correcting claims and just flat out appeal it.
I am not trying to steer you away from the AAPC forum in any manner. You may find some pathology coding relief reaching out for additional pathology resources such as a FB page called "Pathology Coding Across the World". I just presented last Tuesday night on possible ICD impact changes 10/1/2023 for our pathology coding. I felt it was received well and we had fantastic discussions. D48.1 and acute appendix with acute peri-appendicitis
Again, I will not detour anyone for leaving the AAPC forums; just merely offering another source to reach out to in the pathology specialty.
Thank you for listening and have a wonderful evening,
This is the link on modifiers, but if you change the search engine to NCCI you should set okay. https://www.cms.gov/files/document/mln1783722-proper-use-modifiers-59-xe-xp-xs-and-xu.pdf
Dana

Notice: I am simply adding this phrase (no other changes to my original response has changed) ~ please review your other posts kmweigant, I provided additional links to NCCI okay. I wasn't acclimated/familiar that you were struggling finding this intel until I reviewed your next post and replied there.
 
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HELLO, I AM BILLING CLERK FOR PATHOLOGY LAB, AND WE HAV RECENTLY BEEN RECEIVING TOENAIL SPECIMENS. I WAS WONDER SHOULD POTASSIUM HYDROXIDE FOR A TOENAIL BE CODED AS 88311?

THANK YOU
 
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