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Thread: Pathology codes using modifiers

  1. #1

    Default Pathology codes using modifiers

    AAPC: Back to School
    Good morning all,

    I need some assistance with billing pathology codes listed below: the edit says 88323 unbundles to Hx procedure 88321 I tried using mod. 59 on each and I'm having diffculty with this claim any suggestions?

    88342 - mod 59

    Thank you,

  2. #2

    Default cpc

    CMS (Medicare) only allows one code in the 88321-88323 range per date-of-service. Date of service is determined by the date the specimen was archived from storage and sent for second opinion. For any ancillary service YOU performed, such as a special stain, IHC, etc., then you append modifier 59 to that service. If you do cut into a block for ancillary service, CMS instructs that you then use cPT 88323 for the consult code (which I still don't get, but it's Medicare rule). So if you performed an IHC on a second opinion consult, regardless of how many separate accessions were received that date, per Medicare guideline you'd code


    (this of course assuming you're billing global)


  3. #3


    Thank you so much that was very helpful information I will let the pathologist know this .

    Thank you,

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