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Billing pathology with multiple units

Marcy Posted Mon 11th of February, 2013 20:22:22 PM

One of our Gastroenterologist performed a follow up colonoscopy on an est. pt with a 10 year history of ulcerative colitis. The physician removed a 3 mm polyp with cold biopsy forceps in the sigmoid colon. He also obtained biopsies every 10 cm because of the pts. longterm ulcerative colitis. The charge was 88305 x 13 units and 88312x 1 unit. Medicare paid for the 88312 and denied 88305.
I have tried to find the actual policy regarding maximum unit edits and have been unable to find it. I want to make sure I use modifier 59 correctly. Any advice you can give me would be appreciated.

SuperCoder Answered Mon 18th of February, 2013 02:45:42 AM

We apologize for the delay.My editor is working on this. She will get back very soon. Thanks for being patient.

SuperCoder Answered Mon 18th of February, 2013 08:52:25 AM

As per CPT guidelines:

"The unit of service for codes 88300 through 88309 is the specimen."

As per CPT Assistant Dec 2011:

"In addition, the unit of service for codes 88300-88309 refers to the specimen. Therefore, if the gallbladder material received for pathologic examination comprising multiple specimens for individual and separate attention and individual examination and pathologic diagnosis, each specimen’s gross and microscopic examination performed is considered a single unit of service. The appropriate surgical pathology code should be reported. Codes 88300-88309 do not include the services described by codes 88311-88388."

Therefore no published MUE value for the code 88305 is available. Was there any particular reason for denial?

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