Pathology Billing: Calculate How MUE/CCI Restricts Your Outside Consult Pay
Posted on 17. Jan, 2010 by Editor in Hot Coding Topics
Don’t bank on accepted 88321-88323 unit of service.
Your pathologist consults with an outside lab on slides taken from a 2006 lumpectomy and a 2009 lymph node fine needle aspiration (FNA). That’s 88321 x 2 — right?
Maybe. Your payer determines the answer to that question.
The problem: “Although the American Medical Association (AMA) says the unit of service for pathology consultation codes 88321-88325 is ‘each case,’ CMS begs to differ,” says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc., publisher of the Pathology Service Coding Handbook, in The Villages, Fla.
Distinguish CPT Rules
CPT provides three codes for pathology consultations on material referred from an outside institution:
• 88321 — Consultation and report on referred slides prepared elsewhere
• 88323 — Consultation and report on referred material requiring preparation of slides
• 88325 — Consultation, comprehensive, with review of records and specimens, with report on referred material.
The unit of service for codes 88321-88325 is “the surgical pathology case or cytopathology case,” according to the Dec. 2002 CPT Assistant.
The “case” refers to all slides or material associated with a single procedure date. That’s why our opening example of a consultation on slides taken from a 2006 lumpectomy and a 2009 lymph node FNA should be 88321 x 2, per CPT rules.
Tip: “Think of the ‘case’ as all referred material associated with the accession number assigned by the referring lab,” Padget says. “The case might include multiple specimens, but the outside lab normally would include all of them under a single case accession number. Different cases on different days would have different accession numbers.”
For instance: Your pathologist receives two surgical cases for consultation. The first includes slides from a lesion excision dated Feb. 13, 2009, with a melanoma diagnosis, margins not clear. The second includes slides from a re-excision of the...
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