Wiki Pathology codes using modifiers

[tholcomb]

Good morning all,

I need some assistance with billing pathology codes listed below: the edit says 88323 unbundles to Hx procedure 88321 I tried using mod. 59 on each and I'm having diffculty with this claim any suggestions?

88321
88323
88321
88321
88321
88342 - mod 59

Thank you,
TH

 

[pamdines]

cpc

CMS (Medicare) only allows one code in the 88321-88323 range per date-of-service. Date of service is determined by the date the specimen was archived from storage and sent for second opinion. For any ancillary service YOU performed, such as a special stain, IHC, etc., then you append modifier 59 to that service. If you do cut into a block for ancillary service, CMS instructs that you then use cPT 88323 for the consult code (which I still don't get, but it's Medicare rule). So if you performed an IHC on a second opinion consult, regardless of how many separate accessions were received that date, per Medicare guideline you'd code

88323
88342.59

(this of course assuming you're billing global)

pam

 

[tholcomb]

Thank you so much that was very helpful information I will let the pathologist know this .

Thank you,
th