Wiki Laterality denials for path?

[treinemer]

Hi All,

I have been seeing denials for multiple scenarios for missing modifier. These are cases where no modifiers are needed, ie. 88305, 88350, 88346. Non pbb clinic, commercial payor. The only thing I can think of is, besides just denying to deny, is that they want a laterality modifier, this particular one is for an arm. We have not seen/used laterality on the path codes before so wondering if something changed, or if we should have been using them and insurance is getting on them.

Thanks!

 

[danachock]

Hello treinemer,
No, I don't believe they are looking for laterality here (in my opinion of course).
Let me throw out a fictional example here using your CPT codes and no other charges:

Pathology department receives Specimen A
let's just state it was a skin biopsy (gross and microscopic performed) and at the end of the day we bill 88305x1.

Pathology department receives Specimen B for IF studies that include (IgA, IgG, IgM, C1q, fibrinogen) and at the end of the day we bill 88346x1, 88350x4 here.

First are all the charges on the same invoice together billing 88305x1, 88346x1, 88350x4?

Or are you billing something like this?
88305x1
88346x1
88350x1
88350x1 (this would need a modifier)
88350x1 (this would need a modifier)
88350x1 (this would need a modifier)

Let's triage the coding issue here. It is really important to view the claim that was billed with the charges and how all the charges populate with the quantities.
I know that many coders have a picture of how the claim was billed out, but did you look at the claim? Sometimes charges may split (versus quantity bill) that you may not be aware of.
I am hopeful that I provided some advice. There is really limited information. Insurance companies are sometimes slow updating their software for claims, sometimes as a "coder" we don't realize that what we felt should have been billed together because all the charges were in the WQ together (didn't bill like that on the claim together). No worries, again we triage what is happening and hopefully figure out what is happening here.
Thank you for listening,
Dana

 

[treinemer]

Hello treinemer,
No, I don't believe they are looking for laterality here (in my opinion of course).
Let me throw out a fictional example here using your CPT codes and no other charges:

Pathology department receives Specimen A
let's just state it was a skin biopsy (gross and microscopic performed) and at the end of the day we bill 88305x1.

Pathology department receives Specimen B for IF studies that include (IgA, IgG, IgM, C1q, fibrinogen) and at the end of the day we bill 88346x1, 88350x4 here.

First are all the charges on the same invoice together billing 88305x1, 88346x1, 88350x4?

Or are you billing something like this?
88305x1
88346x1
88350x1
88350x1 (this would need a modifier)
88350x1 (this would need a modifier)
88350x1 (this would need a modifier)

Let's triage the coding issue here. It is really important to view the claim that was billed with the charges and how all the charges populate with the quantities.
I know that many coders have a picture of how the claim was billed out, but did you look at the claim? Sometimes charges may split (versus quantity bill) that you may not be aware of.
I am hopeful that I provided some advice. There is really limited information. Insurance companies are sometimes slow updating their software for claims, sometimes as a "coder" we don't realize that what we felt should have been billed together because all the charges were in the WQ together (didn't bill like that on the claim together). No worries, again we triage what is happening and hopefully figure out what is happening here.
Thank you for listening,
Dana

Interesting thought Dana. I didn't think about that possibility. Unfortunately in this case it was billed with the quantity on the line and not broken out.

It is such a guessing game from insurance to insurance. Now I am wondering if they might want it broken out to line item with modifiers.

Thanks for your reply!