MCCONKEYT
Guest
I would appreciate input from the community on the following new Medicare ruling regarding prostate biopsies.
"In its decision, CMS established new G codes (G0416-G0419) which will apply to all prostate biopsies (regardless of surgical technique) when 10 or more specimens are reviewed. Increased scrutiny in the reporting of multiple prostate biopsy specimens led to this policy change. Prostate biopsies with fewer than 10 specimens should be billed using CPT code 88305." Per College of American Pathologists, Statline, December 5, 2013 • Volume 29, Number 24
We bill for the professional component for our local pathologists. Normally, we submit 12 units of 88305 which is the max allowed by our MAC. However, given the new ruling, can we submit 9 units of 88305 and then 1 unit of G0416? One of our doctors thinks we can bill it this way. Do we only submit 1 unit of G0416? There is going to be a large reduction in reimbursement if we are only allowed to bill G0416.
Would we be out of compliance if instead of billing 12 units, we only bill 9 and use 88305 only? Would that be considered undercoding?
"In its decision, CMS established new G codes (G0416-G0419) which will apply to all prostate biopsies (regardless of surgical technique) when 10 or more specimens are reviewed. Increased scrutiny in the reporting of multiple prostate biopsy specimens led to this policy change. Prostate biopsies with fewer than 10 specimens should be billed using CPT code 88305." Per College of American Pathologists, Statline, December 5, 2013 • Volume 29, Number 24
We bill for the professional component for our local pathologists. Normally, we submit 12 units of 88305 which is the max allowed by our MAC. However, given the new ruling, can we submit 9 units of 88305 and then 1 unit of G0416? One of our doctors thinks we can bill it this way. Do we only submit 1 unit of G0416? There is going to be a large reduction in reimbursement if we are only allowed to bill G0416.
Would we be out of compliance if instead of billing 12 units, we only bill 9 and use 88305 only? Would that be considered undercoding?