Reyna Posted Fri 30th of March, 2012 21:38:22 PM
My lab keeps getting denied for billing the PIN-4 cocktail as 88342 x 3 (Cocktail contains 3 anti-bodies). Should it be coded as one anti body per line item? ex; 88342 x 1, 88342 x 1, 88342 x 1 Etc.
I heard a new law passed as of Jan 1st we can no longer bill the cocktail as x3 rather we should bill x's 1. Please advise!
SuperCoder Answered Fri 30th of March, 2012 21:47:43 PM
Code 88342 is reported once per antibody, per specimen.
Reyna Posted Mon 02nd of April, 2012 21:49:29 PM
Right but when it comes to the PIN-4 cocktail, their are 3 anti-bodies (on one slide) per specimen. Is the cocktail considered one antibody or three? What is the Medicare guideline for this?
SuperCoder Answered Tue 03rd of April, 2012 07:01:35 AM
Yes, PIN-4 cocktail contains 3 anti-bodies, but from billing point of view and as per new guideline, it should be reported only once. Before Jan, it was reported x 3.
Guideline: Notice ‘Cocktail’ Difference
Another way you stand to lose IHC stain pay involves Medicare’s new policy for multiple-antibody stains.
Prior to Jan. 1, an IHC stain comprised of multiple antibodies warranted multiple units of service as long as you documented that each antibody provided distinct diagnostic information. Not anymore. The latest NCCI Policy Manual states:
"Physicians should not report more than one unit of service per specimen for an immunohistochemical antibody(s) stain (procedure) even if it contains multiple separately interpretable antibodies."
In other words, "IHC ‘cocktail’ stains such as PIN4 must now be billed as one unit (one stain) even though multiple antibodies will be individually reported."
Old way: A prostate triple stain (PIN4) contains three antibodies -- p504S, which stains adenocarcinoma cytoplasm red; P63, which stains basal cell nuclei brown in prostatic intraepithelial neoplasia (PIN); and CK903, which stains basal cells in benign and PIN specimens. With documentation of the diagnostic contribution of each stain, bill 88342 x 3.
New way: For the same stain and documentation, you can bill only 88342 for a Medicare beneficiary. That would cost your lab $211.04 in lost revenue (2012 physician fee schedule national amount, conversion factor 34.0376)