Wiki Surgical Pathology/Modifier 52

[Lynne77]

Hello!

I bill for a dermatology practice with a dermatopathology lab. Our system coded the path for one of our patients an an 88305, but it was missing a diagnosis. The path report shows no diagnosis and states that the "tissue did not survive processing." Are we able to bill for the path in this instance? Maybe 88305-52 (reduced/discontinued service) or does that modifier only apply to procedures? Thanks in advance for your help!

 

[thomas7331]

I don't think that modifier is appropriate since that is to report a service that was partially performed but reduced at the physician's discretion. In the situation you are describing, the pathology service was not performed at all because the tissue was not able to be prepared for the physician's review. You will be billing the patient's plan for a service that has zero clinical value. I would recommend just writing this off as a cost of doing business.

 

[danachock]

Hi Lynne77;
Well, I don't work in compliance, but there are two parts of your question here.
FIRST: receiving a specimen with no diagnosis code is not appropriate or compliant. Every surgeon/clinician/derma-path needs to state the reason exactly why that specimen was accessioned.
That specimen should not be reviewed by anyone in the pathology department until it was accessioned correctly!!!
If the indication or clinical indication is absolutely empty ~ you absolutely refuse it! This is not my rodeo, but nope, this is probably a compliance issue. Or new accessioner??
SECOND ~ Next, "tissue didn't survive processing"; pathologist's reviewed under microscope and nothing there. What is your facilities policy on when this event happens?
In my opinion this should not be made on the coder level but SERIOUSLY ON THE PROVIDER OR COMPLIANCE LEVEL.
This angers me, the pathologist reviews the documentation and charges and submits them.
That CLEARLY isn't the pathology coder's responsibility. That is the "whole umbrella" that lives stories above pathology coding making bigger $$ deciding on what to do. Be cognizant and ask.
You need to ask so many questions and figure out how to push forward.
Thank you for listening,
Dana

 

[Lynne77]

Thank you both for your help... Just to clarify, the specimen was accessioned correctly... The dx that was sent with the specimen was D48.5. It's just that when the pathologist finalized the charge and we received it, there was no dx because nothing was found since the tissue did not survive. I agree that it's not the pathology coder's responsibility, but I think it's more of a system issue (or system user issue)... luckily we have very honest providers and I don't think he was intentionally trying to bill for something he shouldn't. I was also thinking this should just be adjusted, so that's what we're going to do!