Venkataraman Posted Wed 13th of November, 2013 11:26:56 AM
BCBS has replaced 88172 with G0144. Can I add a modifier 52 to the G code for imager failure? And am I able to continue to bill out 88172 for all other carriers?
SuperCoder Answered Wed 13th of November, 2013 23:39:50 PM
The answer to your question depends partly on the payer. The correct codes for the scenario are 88172 (Cytopathology, evaluation of fine needle aspirate; mmediate cytohistologic study to determine adequacy of specimen[s]) and 88173 (...interpretation and report). The payer variation has to do with how many units of service you can report for the 88172 adequacy check.
Medicare is different:"The unit of service for CPT code 88172 is the separately identifiable lesion (tumor); ... all specimens from a single lesion are included in a single unit of service." The manual goes on to say that if a physician performs multiple "passes" into the same lesion to obtain multiple samples for immediate cytohistologic study, you can claim only one 88172 for all passes from a single lesion.
That doesn't mean you can never report two units of 88172. The policy manual states, "A separate unit of service may be reported for each distinct, separate lesion, but only one unit of service may be reported for all specimens from a single lesion."
You can choose to add Modifier 52 for image failure with modifier 52
Venkataraman Posted Thu 14th of November, 2013 09:58:42 AM
I apologize, I miskeyed the cpt code in my question. My question should have included cpt code 88175 and G0144. Can you please review the question using the cpt codes 88175 and G0144 and respond? Thank you.
SuperCoder Answered Fri 15th of November, 2013 11:51:27 AM
You should not bill a Pap smear if you’re not able to complete the service due to equipment failure. That means you shouldn’t bill it, even with modifier 52.
Regarding whether to use 88175 or G0144 – that’s payer specific. Medicare requires the G codes for Pap smears, but many private payers use the CPT codes.
88175 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with screening by automated system and manual rescreening or review, under physician supervision
G0144 SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION, WITH SCREENING BY AUTOMATED SYSTEM, UNDER PHYSICIAN SUPERVISION
52 Reduced services