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88342 new medicare guidelines

  1. Default 88342 new medicare guidelines
    Clearnace Sale
    I live in PA and the policy for 88342 that just became active is insane. We have been getting denied for all the 88342's we bill. The policy is called
    LCD L30538 - Cytogenetic Analysis, and our 88342 are not being done for cytogenetic analysis but this doesn't seem to matter at all. We had to file over 40 appeals in the last week. If you call you just get a big run around. Even when the dx does happen to be on the policy it still is denying, I am hoping that this policy has this cpt on it in error. ( it also has 88365 and 88368) Has anyone else been having problems. We have highmark medicare here in Pennsylvania.

  2. Default
    here is the link to the policy if anyone is interested


  3. #3
    Agreed this policy is misleadingly titled. What does CG have to do with 88342? We were having a problem a while back with 88342 greater than nine units, but that's stopped (MA) after we appealed a few.

    This is probably some snafu at Highmark. Good luck. Hopefully they'll correct it on their end quickly.

  4. #4
    Mannlx- are you reporting a -59 on these 88342 units? Do you regularly? This isn't really pertinent to your problem (perhaps) but it seems we are using -59 more often than I think we should be.
    Thanks. WK

  5. Default
    Good news!!! They revised the policy and elminated 88342 from the list. The bad news is we still have to appeal every claim denied from dates of service 3/10/10 to 4/15/10. I guess Highmark got tired of the phone calls and appeals!!!!!

  6. Wink
    I know I was so excited when I saw that they removed it , they are wrong to make us appeal , if it was a typo they should reprocess. But I won't complain at least it is gone. Did you notice they didn't pay weather it was on the policy or not, it also had to have that stupid V49.89 code to pay as secondary dx.
    And for the other question, yes we bill lots of units of 88342, we had one yesterday with 49 units, but we only use the 59 if say they do 20 and then a few days latter do more, then we put the 59 on that to show it is not a dup to the original but it usually denies and needs appealed any way. ( we also use the 59 if pt has more than one report on that day, like a bx with stains and a cytology report with stains. )

  7. #7
    Sounds right. Thanks for the input. Congrats on the policy reversal.

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