Wiki prostate biopsy - hospital billing

[tpadmasree@gmail.com]

Hi,
I am looking for help/suggestions to code the following scenario related to pathology study. We are facing issue to submit right codes for billing.

- Hospital lab receives specimen tissues from physician office for pathology study. Lab receives multiple specimens (12 in 12 jars) for the prostate biopsy foe mostly Medicare patients.
- Lab/Pathologist studies all 12 specimens individually and reports 12 final diagnoses for specimens/sites A - L.
- We are coding G0416 x 1 and 88344 x 12.
- We get paid for G0416 and 88344 x 1 (as 88344 has MUE 1 listed).
Please suggest me the proper correct way to code for this scenario. Also, if possible, what will be the highlighting points in reading prostate biopsy path report?
Thank you.

 

[Machelle Freeman]

I do office billing not hospital. But, I can tell you we bill G0416 and 88344, 88344-59, 88344-59, etc. for Medicare. Hope this helps.

Machelle Freeman, CPC

 

[tpadmasree@gmail.com]

We are getting paid for G0416 and 88344 X 1. The rest of 88344 X 11-59(11 specimens) are rejected with reason code, "Exceeds max no of units". That's the issue!. Thank you

 

[whitney1802]

Stand alone pathology lab

We had to re-work this a bit to finally get paid and this is what worked: for government payers 88344 x 1, 88344-xs x 1, 88344-xs x 1, etc
Commercial it would be 88344 x 1, 88344-59 x 1, 88344-59 x 1, etc

Hope this helps!

 

[tpadmasree@gmail.com]

Thank you. Have you got paid by using modifier "XS"? We just sent 5 test claims today. For Mdcr we used G0416, 88344, 88344-59, 88344-59 etc as each separate line item. I will update with our outcome.

 

[danachock]

88344

This code 88344 has a MUE of 1 with MAI of 1 = "line edit" the MAI with continue to be adjudicated as the line edit on the claim is auto-adjudicated by the contractor." (Summary - it doesn't matter how many specimens were stained but that is what you will get paid for). The billers "behind the scenes" will adjust what we are allowed to bill per the MUE edit. Goodness, if tpadmasree@gmail.com claims are paid; I'd like to know so we can maybe allocate an alternative modifier.
Thanks in advance;

Dana Chock
Anesthesia, Pathology, Laboratory, Radiology Coder (CPC, CANPC, CHONC, CPB, CPMA)

 

[whitney1802]

Thank you. Have you got paid by using modifier "XS"? We just sent 5 test claims today. For Mdcr we used G0416, 88344, 88344-59, 88344-59 etc as each separate line item. I will update with our outcome.

Yes our claims are getting paid with the xs modifier.

 

[danachock]

prostate biopsy

Great news on the XS modifier billing these!!! Thank you so much for sharing your new findings.