Wiki UroVysion FISH-INSUFFICIENT CELLS

[Tara0513]

Hello,
Independent laboratory is sent urine from a urology group to run UroVysion FISH and the samples submitted are inadequate due to insufficient sample volume. The lab performs all the work (report copied below following HIPAA) only to see that it is insufficient. Can we still bill for services since the lab did perform all this work and does not know the sample is insufficient until everything is done?

Under Gross description it states that the condition of the specimen is acceptable but once everything is done its insufficient. Help with this would be as always greatly appreciated!

 

[LeticiaS]

Hello Tara,

I know that this is a late response but hopefully this will help for future cases like this.

Short, Direct Answer​

Yes, the laboratory may bill for services performed even if the final result is insufficient, as long as the testing was actually performed and documented.
The determination of insufficiency can only be made after processing and analysis are attempted. In this case, interphase FISH analysis was performed, probes were applied, and nuclei were evaluated; therefore, the work was not canceled prior to testing and is billable.

Why billing IS appropriate in this case​

1.​

• The report clearly documents:
  
  • FISH analysis was performed
  • Probes were applied
  • Nuclei were examined
  • A quantitative limitation was identified (<25 cells available)
• This is post-analytic insufficiency, not a pre-analytic rejection

Key rule:
If insufficiency is identified only after testing is attempted, the service is bil

This is NOT a “test not performed” scenario​

Billing would not be allowed only if:

• The lab rejected the specimen upfront, OR
• Testing was canceled before analysis began

That did not happen here.

CPT rules support billing when analysis is attempted​

For molecular and cytogenetic testing (including FISH):

• CPT is based on work performed, not diagnostic success
• An inconclusive / insufficient result does not negate the technical or professional work

Your report documents:

• Probe hybridization
• Enumeration
• Interpretation
• Final signed report

That satisfies CPT requirements.

“Insufficient” ≠ “No work done”​

The phrase:

“Insufficient cells for evaluation”

means:

• Not enough cells to meet interpretive thresholds
• NOT that the assay wasn’t run

This distinction is critical for auditors.

ow this should be documented (you already have this ✔)​

Your report does the right things:

• States the limitation
• Explains why the result is inconclusive
• Recommends repeat testing
• Includes technical and interpretive detail

This is exactly what payers expect to see.

ow this should be documented (you already have this ✔)​

Your report does the right things:

• States the limitation
• Explains why the result is inconclusive
• Recommends repeat testing
• Includes technical and interpretive detail

This is exactly what payers expect to see.

 

[sls314]

Hello Tara,

I know that this is a late response but hopefully this will help for future cases like this.

Short, Direct Answer​

Yes, the laboratory may bill for services performed even if the final result is insufficient, as long as the testing was actually performed and documented.
The determination of insufficiency can only be made after processing and analysis are attempted. In this case, interphase FISH analysis was performed, probes were applied, and nuclei were evaluated; therefore, the work was not canceled prior to testing and is billable.

Why billing IS appropriate in this case​

1.​

• The report clearly documents:
  • FISH analysis was performed
  • Probes were applied
  • Nuclei were examined
  • A quantitative limitation was identified (<25 cells available)
• This is post-analytic insufficiency, not a pre-analytic rejection

Key rule:
If insufficiency is identified only after testing is attempted, the service is bil

This is NOT a “test not performed” scenario​

Billing would not be allowed only if:

• The lab rejected the specimen upfront, OR
• Testing was canceled before analysis began

That did not happen here.

CPT rules support billing when analysis is attempted​

For molecular and cytogenetic testing (including FISH):

• CPT is based on work performed, not diagnostic success
• An inconclusive / insufficient result does not negate the technical or professional work

Your report documents:

• Probe hybridization
• Enumeration
• Interpretation
• Final signed report

That satisfies CPT requirements.

“Insufficient” ≠ “No work done”​

The phrase:




means:

• Not enough cells to meet interpretive thresholds
• NOT that the assay wasn’t run

This distinction is critical for auditors.

ow this should be documented (you already have this ✔)​

Your report does the right things:

• States the limitation
• Explains why the result is inconclusive
• Recommends repeat testing
• Includes technical and interpretive detail

This is exactly what payers expect to see.

ow this should be documented (you already have this ✔)​

Your report does the right things:

• States the limitation
• Explains why the result is inconclusive
• Recommends repeat testing
• Includes technical and interpretive detail

This is exactly what payers expect to see.

That reads like it was cut and pasted from ChatGPT, which is not a reliable source

Hello Tara,

I know that this is a late response but hopefully this will help for future cases like this.

Short, Direct Answer​

Yes, the laboratory may bill for services performed even if the final result is insufficient, as long as the testing was actually performed and documented.
The determination of insufficiency can only be made after processing and analysis are attempted. In this case, interphase FISH analysis was performed, probes were applied, and nuclei were evaluated; therefore, the work was not canceled prior to testing and is billable.

Why billing IS appropriate in this case​

1.​

• The report clearly documents:
  • FISH analysis was performed
  • Probes were applied
  • Nuclei were examined
  • A quantitative limitation was identified (<25 cells available)
• This is post-analytic insufficiency, not a pre-analytic rejection

Key rule:
If insufficiency is identified only after testing is attempted, the service is bil

This is NOT a “test not performed” scenario​

Billing would not be allowed only if:

• The lab rejected the specimen upfront, OR
• Testing was canceled before analysis began

That did not happen here.

CPT rules support billing when analysis is attempted​

For molecular and cytogenetic testing (including FISH):

• CPT is based on work performed, not diagnostic success
• An inconclusive / insufficient result does not negate the technical or professional work

Your report documents:

• Probe hybridization
• Enumeration
• Interpretation
• Final signed report

That satisfies CPT requirements.

“Insufficient” ≠ “No work done”​

The phrase:




means:

• Not enough cells to meet interpretive thresholds
• NOT that the assay wasn’t run

This distinction is critical for auditors.

ow this should be documented (you already have this ✔)​

Your report does the right things:

• States the limitation
• Explains why the result is inconclusive
• Recommends repeat testing
• Includes technical and interpretive detail

This is exactly what payers expect to see.

ow this should be documented (you already have this ✔)​

Your report does the right things:

• States the limitation
• Explains why the result is inconclusive
• Recommends repeat testing
• Includes technical and interpretive detail

This is exactly what payers expect to see.

I ask this with kindness, but that was cut and pasted directly from ChatGPT, wasn't it?

Remember that ChatGPT is far from a reliable source for coding and billing guidelines.