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G0452 BILLING

Apurva Posted Thu 06th of February, 2020 22:13:47 PM
Can we bill G0452 CPT code on PCRs for fungus (physician interpretation and report for molecular pathology procedure) if I am adding a written interpretation and summary as a front page cover page (correlation between histology results and the PCR results)? This code seems to get denied by novitas Medicare.
SuperCoder Answered Fri 07th of February, 2020 05:45:54 AM

Hi,

Thanks for your question.

To receive reimbursement for code G0452, you must have a request for interpretation by the patient’s attending provider or by standing order of the hospital’s medical staff; exercise of medical judgment by the consulting physician provider, i.e., the interpretation of a pathologist must be medically necessary; and the interpretation must be written in a narrative report included in the patient’s healthcare record.

Code G0452 suggests that the provider, a specialist physician in molecular pathology, interprets molecular pathology test results and provides a meaningful written report that adds information not provided by the laboratory result itself as a matter of medical necessity for the patient. Molecular pathology diagnoses disease by assessing the molecules within cells or tissues, especially the identification of genes associated with disease and chromosome abnormalities.

You have to also check with the payer for Explanation of Benefit (EOB) for the denial of this code.

Thanks.

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