Wiki Consults pathology and medicare

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mdzialo

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Billing for the pathologists, 88325, consultation with review of records and specimens, with report on referred material. Medicare will not pay because this is a "consult" code.
Does anyone have any idea how to bill this to Medicare? They referred us to the E&M codes, but you cant use these......
Thanks
 
This isn't the kind of consult Medicare should be denying. Appeal with the report but make sure the documentation is strong enough to support 88325. If not, you may only get an 88321 out of it and also a can of worms. It should explicitly say what records were reviewed and how they influenced the final dx.

Good luck,
WK
 
There was a new ruling by medicare for 2010 on the technical component of 88321 & 88325. The professional is ok, but the technical was going to be denied. 88323 where techs do work up a block or slides still has technical. Other payors may still reimburse. If you need a reference, I'll look it up, I should have saved that info somewhere.
 
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