BlakeCarswell82
Guru
I work for a pathology lab. I understand the changes with G0416 and also with the cocktail IHC stains (88342). However, I am thoroughly confused by why Medicare denies our IHC stains. If we have a malignant code (185), they will pay us for two immuno stains, usually without an appeal. If there are more than two, we will get denied all of them. If we have codes for prostatitis (601.0 and 601.1), hypertrophy (600.90, 600.91), atypical prostate (602.3), or atrophy of the prostate (602.2), we can get paid for more than two IHC stains if we appeal and documentation states that we were testing for a "suspicious focus." However, it seems to be completely random as to whether we get a favorable or unfavorable appeal. Help, please! Why is Medicare not paying for more than two IHC stains, and why are we getting denials on certain codes?
I have checked MUEs and NCCI edits, and I determined it isn't hitting against another code. I am at a loss.
I have checked MUEs and NCCI edits, and I determined it isn't hitting against another code. I am at a loss.
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