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88305 - Path Codes

Marlene Posted Tue 27th of August, 2013 20:46:10 PM

We are billing the following codes and have received a denial on the 88305...Please tell me what I may be missing as far as modifiers?? I checked the CCI edits and no modifier is needed on the 88305. The doctor reads the Pathology in the clinic and provides interpretation. The patient was seen at a outpt hospital setting. Payor is Medicare.

99203-25 Dx 692.74 POS 22
17000 x 1 Dx 702.0 POS 22
17003 x 2 Dx 702.0 POS 22
11401-59 x 1 Dx 238.2 POS 22
88305 x 1 Dx 238.2 POS 11

Any help would be great...Thxs

SuperCoder Answered Wed 28th of August, 2013 01:04:40 AM

Use Modifier TC with 88305

Marlene Posted Wed 28th of August, 2013 12:18:43 PM

Ok - Just to clarify...This doctor performs the removal of the lesion and reads the path. You put the TC modifier on it to show only the technical part was done? Does it reduce payment? We origianlly were using the 59 modifier and it was being paid with that but it doesn't seem correct as only one unit is being billed. Thoughts? Thxs so much for any advice...

SuperCoder Answered Thu 29th of August, 2013 22:51:42 PM

I will answer this soon.

SuperCoder Answered Thu 29th of August, 2013 22:51:42 PM
With me
SuperCoder Answered Mon 02nd of September, 2013 16:17:36 PM

The most significant change is in the CPT code 88305 Technical Component (TC) which will be lowered by 52%. Although the professional component will be increased by 2%, the global payment for 88305 will decrease by 33%.

Both the CAP and ASCP have recently written letters to CMS, urging it to reconsider its decisions to slash 88305 reimbursement and to place molecular pathology codes on the Clinical Laboratory Fee Schedule (CLFS) and not the Physician Fee Schedule (PFS).

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