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)
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