Wiki 88342 for multiple stains

[CatchTheWind]

My understanding is that 88342 is for one stain only, and any additional stains are billed as 88341. Our local Medicare's allowance for 88342 is $110.92.

Here's the dilema: A co-worker had a biopsy done and the lab charged her almost $1200 for 88342 (and almost $650 even after insurance adjustment). When she called the lab to ask why the fee was so high, they said it's because they did 22 stains. But how can 22 stains be billed as 88342 x 22?

 

[mitchellde]

If there were 12 different specimens submitted and stains were perfomed on all of them then each one gets an 88342 for the first stain and then 88341 for all of the additional stains added together.

 

[CatchTheWind]

Thanks for the quick response, Debra! Sorry, I made a typo: it was billed as 99842 x 22 (not 12). (I've edited it now.)

The pathologist said he billed for 22 stains; there was no mention of additional specimens.

 

[mitchellde]

It will really depend on how they split the biopsy specimen. if they sent it in one container and the path lab then made 22 slides then they can bill only 1 88342. if the path lab received 22 different containers with specimens, then it does not matter that there was only one biopsy, the lab had to treat each container as a new specimen then each individual specimen in the lab can have an 88342. they can charge only once per stain type so if one specimen had 8 iron stains they can still count only 1. the H&E stain is never billed out. so she really needs to see a copy of the path report. 22 immunostains on a biopsy is really rare so it would be interesting to see the report.

 

[CatchTheWind]

Thanks for explaining it so clearly!

 

[aleigh]

Do you know what type of biopsy she had? 22 specimens is something I would expect to see in a hospital surgery case, usually cancer. For anything else that seems insane.