Wiki 88342 Pankeratin/Calponin cocktail

[BlakeCarswell82]

A coder at a hospital said we cannot charge 88342 X 2 for the Pankeratin /Calponin cocktail stain for Medicare patients. We can charge only X 1. I had heard the update about the prostate panel, but did not know about the Pankeratin / Calponin stains. I cannot find documentation to support what he is saying. He can't remember who told him this new rule. Any help / documentation on this matter would be greatly appreciated.

 

[BlakeCarswell82]

All I need is information on where to look for documentation. We had been charging for each stain. However, the updates may have specified that we can no longer charge for each stain and must bundle them together since it is a "cocktail" stain. I am aware of the updates for prostates (the prostate panel for a Medicare patient can only be charged once even though there are three antibodies used), but I had not read/heard about Calponin/Pankeratin. Please help!

 

[prmcfall]

Check the National Correct Coding Policies for Medicare Services and look under the Anatomic Pathology and look at the MUES for 88342 that is the best explanation I have been able to find when it comes to billing 88342 and any other special stains.

 

[kkonkle]

This information is found in the NCCI policy. It states, "Physicians should not report more than one unit of service per specimen for an immunohistochemical antibody(s) stain (procedure) even if it contains multiple separately interpretable antibodies." Below is the link to the NCCI policy manual 2013 where you can find the complete information.

https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html?redirect=/nationalcorrectcodinited/

 

[prmcfall]

kkonkle is exactly right...... that is the section I was trying to point you to.

Thanks!

 

[prmcfall]

kkonkle is exactly right...... that is the section I was trying to point you to.

Thanks!