Wiki MUE's for 88342-88341

[snwhite0730]

Hello fellow Coders,

I am trying to get a better understanding of pathology coding; I am auditing a claim that was denied for MUE's for code 88342 and 88341. I truly need to understand if this is correct. The provider billed 16 units for 88341/26/59 and 2 units for 88342/26/59. Now in my mind this is coded wrong with the use of the 59 modifier and 2 units of 88342 since the sample/specimen was obtained from the same body part-the small bowel and doesn't fit the description of modifier 59 in NCCI a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury.

But let's say we ignored the improper use of modifier 59 and 2 units of 88342 and went with just the units of 88341 being 16, based on the code description are they correct in counting each antibody stain applied to block B8? (not counting TCK since the same antibody was testing on both) Given my limited knowledge of path coding, it seems that code 88344 should have been used based on the CPT guideline under the code that says: (When multiple separately identifiable antibodies are applied to the same specimen[ie, multiplex antibody stain procedure’, use one unit of 88344) but if 88341 is defined as EACH antibody, would it be correct to bill 16 units?

Specimen Source:
A. Small bowel adhesion.
B. Small bowel.


Additional Tests Performed:
Qualitative Tests Performed
Block Test Result
A1 TCK Positive
B8 TCK Positive
B8 CK7 Negative
B8 CK20 Positive
B8 CDX2 Positive
B8 PAX8 Negative
B8 WT-1 Negative
B8 P53 Wild-type (heterogeneous pattern)
B8 ER Negative
B8 PR Negative
B8 GATA3 Negative
B8 TRPS1 Negative
B8 TTF1 Negative
B8 Napsin-A Negative
B8 Synaptophysin Negative
B8 Chromogranin Negative
B8 CD56 Negative
B8 Ki67 5-10%
Semi-quantitative Tests Performed
Block Test Percent
A: None.

Any clarification would be greatly appreciated! I am totally fine with being wrong, I just really don't understand how these codes work when reading the path report.

Thank you!!!

 

[danachock]

88342 x 2 is accurate (I don't care what you are looking at here, if a IHC stain was provided to two separate specimens DEEMED SPECIMEN A AND B separately) received in pathology department, it is allowed here.
88341x15 for Specimen B
88360 x1 for Specimen B
Insurance payors do not care, you need to arm yourself on what you need to do to appeal this wholeheartedly. The pathologist exceeded MUE and we have a CCI edit because 88360 is not billable with 88342 or 88341 without a modifier. I gave up modifier 59 long ago. I would fall back on appropriate X- modifier here. But again, that is just my personal opinion here.
hopeful you get this worked out,
Dana