Wiki Surgical path codes

[aknight836]

I am looking for clarification on the correct way to bill CPT Surgical Pathology codes when there are multiple specimen. Charges being billed are 88305x2 and 88304x2. Both 88305s have the same diagnosis code and both 88304s have the same diagnosis code. Which of these is the correct way to split and bill the charges? If both are correct please let me know.

A. 88305x1, 88305x1 with modifier 59, 88304x2 with modifier 59

B. 88305x1, 88305x1 with modifier 59, 88304x1 with modifier 59, 88304x1 with modifier 59

 

[danachock]

Hi aknight836
I do apologize if I am missing something here, but neither coding scenario above appears correct from your above example.
Billing 88305 with 88304 on the same DOS does not have a bundling issue. It is the level of Gross and Microscopic being performed by the pathologist.
Let me provide two examples on how this should have been billed okay. One facility doesn't always bill out charges as another facility and I have seen this both ways.

Example A:
Patient has procedure and four specimens each in its separately identified container Labeled A, B, C, & D received for both Gross and Microscopic review by pathologist
Specimen A - Left Nasal Contents which will bill 88305
Specimen B - Right Nasal Contents which will bill 88305
Specimen C - Left Septum biopsy which will bill 88304
Specimen D - Right Septum biopsy which will bill 88304
Example A will bill this out
88305x1 for Specimen A
88305x1 with modifier 59 (or XS modifier) for Specimen B
88304x1 for Specimen C
88304x1 with modifier 59 (or XS modifier) Specimen D

Example B (same example used):
Patient has procedure and four specimens each in its separately identified container Labeled A, B, C, & D received for both Gross and Microscopic review by pathologist
Specimen A - Left Nasal Contents which will bill 88305
Specimen B - Right Nasal Contents which will bill 88305
Specimen C - Left Septum biopsy which will bill 88304
Specimen D - Right Septum biopsy which will bill 88304
Example B from a facility that "rolls up their charges onto one line" will bill this type of scenario out
88305x2
88304x2

Please reach out if I misinterpreted something or if you have additional questions.
Have a great evening,
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT

 

[Lcubed]

Question about this scenario if I may. What are you referring to when you mention "rolls up their charges one one line"? Is this professional billing, technical billing or both? Is this payer related? Also, is it true that some non-Medicare payers would like to see XS instead of 59?

Thanks!

 

[danachock]

Those are fantastic questions Lcubed,
Unsure if it is payer related to roll up charges or not; or if "customer specific preferences" here? What do your internal personal policies state here please for advice?
Some of my customers have "billing logic" to roll up charges as I stated and others prefer to bill each CPT on its own line using a designated modifier (such as 59, XS or XU) for all the charges on same pathology report.
When I worked at UW for those 2.6 years I followed Medicare billing for all accessions and only assigned X* modifiers (never a 59; I only used it as an example for Specimen A, but substitute modifiers may be necessary). Other companies prefer to use XU instead of XS in those scenarios. Some companies have logic in place to "roll up charges". Some do not have that capacity to do that feature.
I did review HB claims back in the day when working denials. It really didn't matter on some of those cases because ancillary services were not getting paid here. (That would be like radiology & pathology and possibly other stuff.) I don't code the other stuff ~ only pathology 100% since 2012.
The DRG was paid, and the rest was written off in my kindest way from an HB claim.
One more question please. Do you have the ability to assign the diagnosis code to the actual charge? Or when you assign diagnosis codes that it is assigned to all the CPT codes? That will unlock additional information.
Please know I am trying to assist and if my questions may be irrelevant to you, they are relevant to me. I am only trying to help and offer the best assistance I can with the resources I have please.
Have a fantastic evening, lets circle the wagons and horses and discuss again tomorrow please.
Dana

diagnosis codes, diagnosis coding