Pathology Consultation of outside slides 88321

[kduty]

Discussion among the pathologists is 88321 x1 for the patient OR 88321 for each surgical case submitted. Can someone help clarify this?

EX: Patient A - slides submitted from outside facility: endometrial case from 2017, hysterectomy from 2017, a second endometrial later in 2017 and vaginal biopsy 2018. Some of us say 88321 x1 but a some say we should be able to do 88321 x4 for the different surgical cases.

 

[ellzeycoding]

The Medically Unlikely Edit (MUE) for 88321 is 1

88321 is billed once, regardless of the number of specimens submitted to the consulting pathologist.

The National Correct Coding Initiative policy files CHAPX-CPTcodes90000-89999.PDF (Pathology and Laboratory Services) page X-15 we see the following excerpt.

“2. CPT codes 88321-88325 describe surgical pathology consultation services to review slides, tissues, or other material obtained, prepared, and interpreted at a different location by a different pathologist and referred to another pathologist for a second opinion. These codes shall not be reported by pathologists reporting a second opinion on slides, tissue, or other material also examined and reported by another pathologist in the same provider group. Medicare generally does not pay twice for an interpretation of a given technical service (e.g., ECGs, radiographs, etc.). CPT codes 88321-88325 are reported with one unit of service regardless of the number of specimens, paraffin blocks, stained slides, etc.”

 

[kduty]

Thank you Karl for the quick reply.