Wiki 88321-88329 Consult Codes

[JGGBALLEN]

Hello and thank you to anyone that replys

A provider was to submit multiple consults for each specimen (same container) received.

My understanding is that if one or multiple specimens are received within one container, only one consult code can be submitted.

Is there any situation that this would NOT be correct?

 

[bbooks]

You are correct about the case being a single use of the consultation code. There is information about this in the Medicare manual and Padgets. I can provide more information later. I'm at work now.

Sue

 

[bbooks]

From the Medicare Manual: "CPT codes 88321-88325 are reported with one unit of service regardless of the number of specimens, paraffin blocks, stained slides, etc. CMS payment policy allows only one unit of service for CPT codes 88321, 88323, and 88325 per beneficiary per provider on a single date of service. Providers should not report these codes on separate lines of a claim utilizing CPT modifiers to bypass the MUEs for these codes."

Padget goes into quite a bit of detail describing how this is somewhat contrary to what the AMA says. He quotes the AMA: “[The] unit of service for codes 88321-88325 is considered the surgical pathology case or cytopathology case, which can include multiple specimens for review.” {CPT Assistant, Dec. 2002} Padget is copyrighted, so I can't quote him, but he talks in detail about the AMA's unit of service being a "case" rather that a "specimen." It would be worth reading if that is something your pathologist wants to do. In the year I have been coding for a pathology group, we have never used multiple instances of 88321-88325.

I hope that helps!

 

[JGGBALLEN]

Hello and once again thank you!
From you previous response I have placed an order the Padget.

The above said, would that apply to intraop consults as well?

brief example: Gross description 6 specimens breast labeled A-F
Intraop consult--AFS (acid-fast stain), BFS (??), CFS (??) Negative for maligancy.
I presume the above are stains on specimens during intraop with the result.

Problem: 1. provider submitted 88331, x3, -26 for above intraop.
Is that appropriate? Based upon report I believe frozen exam was on specimens A,B & C.
If correct, the more appropriate billing should be 88331 -26, 88332 -26 & 88332 -26 (NO UNITS).

2. Are BFS (??), CFS (??) stains? if so, what do they mean?

3. What documentation is required for intraop consult? Should they not document which specimens were actually tested intraop?
I found, allbeit unofficial w/no REGs referenced, in supercoder a "TIP" stating
"Documentation must include diagnoses to support the medical necessity of the test during surgery. In addition, the documentation must support that the test is reasonable and necessary for the diagnoses. The ordering physician/practitioner should retain this information (e.g., history and physical, examination notes, etc.) as well as the order for the test.
Does Padget concur?
Do he reference an example?

Thanks again...greatly appreciated!

 

[JGGBALLEN]

88331 multiple units

Hello and once again thank you!

From you previous response I have placed an order the Padget.

The above said, would that apply to intraop consults as well?

brief example: Gross description 6 specimens breast labeled A-F
Intraop consult--AFS (acid-fast stain), BFS (??), CFS (??) Negative for maligancy.
I presume the above are stains on specimens during intraop with the result.

Problem: 1. provider submitted 88331, x3, -26 for above intraop.
Is that appropriate? Based upon report I believe frozen exam was on specimens A,B & C.
If correct, the more appropriate billing should be 88331 -26, 88332 -26 & 88332 -26 (NO UNITS).

2. Are BFS (??), CFS (??) stains? if so, what do they mean?

3. What documentation is required for intraop consult? Should they not document which specimens were actually tested intraop?
I found, allbeit unofficial w/no REGs referenced, in supercoder a "TIP" stating
"Documentation must include diagnoses to support the medical necessity of the test during surgery. In addition, the documentation must support that the test is reasonable and necessary for the diagnoses. The ordering physician/practitioner should retain this information (e.g., history and physical, examination notes, etc.) as well as the order for the test.
Does Padget concur?
Do he reference an example?

Thanks again...greatly appreciated!