Wiki Medicare Guidelines for CPT 88313

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stacysmith

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Does anyone know where to find information on the CMS website concerning the correct billing for this CPT code when billed with 88305 and 88312? When we do a colonoscopy and bill the pathology we are billing 88305 and 88312 (if necessary) and 88313 if necessary. Medicare denies some of our 88313 codes and some they will pay. I am not sure what the criteria is for how they pay this code as I do see a pattern on their payments. Any help with where to find a publication or information on how to bill this code correctly is greatly appreciated. The publications I have found are not specific in the guideline on how to bill this CPT. Thank you.
 
We started having the same problem. These have not been denied in the past, but now we are seeing them. The reason given from our billing person is "It denied for non covered charges- a normal generic reason code usually. Called Medicare and they said it was a coding/bundling issue with 88313 and 88312."

I see nothing in the manual that address this issues. Has anyone found a better explanation as to why this is now a problem or how to correct it. Would adding a -59 modifier to 88313 be advisable?

Thanks!
 
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