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88300

  1. #1
    Location
    Long Island/New York
    Posts
    1,271
    Default 88300
    Medical Coding Books
    IS ANYONE ELSE GETTING 88300-26 DENIED WHEN PERFORMED WITH ANOTHER CODE WHEN THERE IS NI 59 MODIFIER.

    WHEN I WENT ON THE NCCI EDIT THERE WAS NO LISTING OF THIS SCENARIO. I'M A LITTLE CONFUSED.

  2. #2
    Default
    We're not getting this problem with Medicare, but we do occasionally get it from some of the commercial payers who bundle the 88300 into a higher level exam. As far as I know we send the records on appeal and get paid after that.

  3. #3
    Location
    Long Island/New York
    Posts
    1,271
    Default
    thanks...

  4. #4
    Default
    Since this edit is not sanctioned by the NCCI tables. We keep track of the insurers that maintain this edit and simply add the modifier 59 at charge entry. This will get you paid quicker and avoid timely appeals. But some insurers will still deny and you will have to appeal.

  5. #5
    Default 88300
    Does anyone know if an Ecode can be used with this CPT code 88300 as a primary Dx?

    Thanks!

  6. #6
    Default
    I have never used a E-code as a primary DX for any anatomical pathology specimens. E-codes are intended for reporting in addition to the code(s) that describes the nature of the injury.

  7. #7
    Default
    I usually come across this because some of the pathologists use the E code for gun shot wound when they examine a bullet. Alternatively, they use the superficial foriegn body code (splinter). I change these to complicated open wound based on the clinical history. An E code is not a diagnosis.

  8. Default
    so you bill bullets and splitters, etc, I have not decided if these should be billed, I do realize the pathologist must exam just to say yes it is a bullet, are others billing for these also??

  9. #9
    Location
    Frederick, MD
    Posts
    267
    Default
    We do. But I don't like the lack of dx codes for these specimens.
    Always Seeking

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