Wiki need help with billing 88312 & 88313

[mandy356e]

Hi I am new to pathology billing.

I have a pathology who is billing these special stains for GI group. She is wanting to bill them every time but never mentions the word stain or anything to that affect in her dictation. I was wanting to know what kind of documentation is required in order to bill these stains and when to differentiate between billing 88312 and 88313 together or seperately. Pathologist typically bills 88305, 88313, 88342, for the professional component but the Lab bills 88305, 88312, 88313, 88342 for the technical component.

Which is right the Lab or the Pathologist.:

 

[calexander1265]

They kind of stain being used and the reason for the stain is what drives the code selection. The dictation should definitely state the type of stain used (example gimsea stain) , this shows the stain being used is not a routine stain (which is not billed separately). The 88312 is for microorganisms and the 88313 is for all other, CAP has some good educational information regarding appropriate use of stains. 88342 is for the immunohistochemical stains. Why the lab and the physician are billing different PC and TC codes tells me there is a problem, these codes should match.

 

[jleakey]

The code selection on special stains are driven by the type of stain. Pathologists should provide as much documentation as possible to support the CPT codes assigned. There are some special stains for organisms that can be performed be either special stains or by IHC stains, so documenting the methodology is very important. They should mention the name of the stain and the findings as well.