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Possible CPT/Modifier to be used for a second opinion on a biopsy

Oscar Posted Fri 20th of July, 2018 12:47:36 PM
Hello, we have a 88323 that was billed and when the results came back from the lab, our physician wanted it sent to a second lab for a second opinion. Is that a CPT code or a modifier that could be appended to bill an insurance for a second opinion?
SuperCoder Answered Mon 23rd of July, 2018 09:22:11 AM

Hi Oscar, 

In cases where the physician feels necessary to send the slides for second opinion, CPT code 88321 will be correct for the scenario.

Further query is welcome. 

Oscar Posted Tue 24th of July, 2018 06:13:38 AM
To clarify, rather than bill a 88323 with an additional modifier signifying this is being sent for a second opinion, you suggest billing CPT code 88321?
SuperCoder Answered Wed 25th of July, 2018 03:17:32 AM

Hi Oscar,

The second opinion or sending the slides for review to another lab will always be billed using CPT code 88321. The use of modifier will be only in the cases where the initial sample is billed using a pathology code and the second opinion will require modifier 59. In addition, if the pathologist you are billing for received slides from an outside lab for a consultation or specialized opinion, and the slides were reviewed by the pathologist you are billing for and diagnosis is rendered, the pathologist you are billing for may bill for 88321. In this case you are billing the insurance company for the consultation provided by the pathologist you are billing for. You will not bill for the surgical pathology codes. If the pathologist you are billing for deemed it was medically necessary to perform special stains and rendered a diagnosis of those stains, you will then bill for 88323 as well as the special stain charges.

Hope this helps!

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