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Slide consults

Trisha Posted Tue 13th of August, 2013 14:15:32 PM

88321
At the request of an outside physicina and/or patient we perform a slide consult, (second opionion on a previously diagnosed case)
I need clarity on how to bill for a few scenarios
if we are given several slides for one site labeled as A:Left neck lateral, B: left neck medial how would we bill
OR
A: left neck block 1 B: left neck block 2 how would we bill
OR
Left neck from one laboratory and a seperate report and slide from a totally different lab that is left neck or even left neck lateral?
How do we bill????
Thanks so much for your assitance

SuperCoder Answered Fri 16th of August, 2013 18:17:02 PM

Hi,

We are working on this case. My editor will come up with a definitive answer.

Thanks

SuperCoder Answered Fri 16th of August, 2013 18:42:39 PM

Hi,

We are working on this case. My editor will come up with a definitive answer.

Thanks

SuperCoder Answered Fri 16th of August, 2013 18:42:39 PM
Forwarded to Ellen
SuperCoder Answered Mon 19th of August, 2013 20:07:55 PM

You should bill the first example as 88321, because you receive prepared slides. You should bill the second example as 88323, because you receive blocks of tissue and prepare your own slides. The reason you bill only one unit of service is that, unlike surgical pathology codes, the unit of service for 88321-88325 is not the specimen -- it is the "case" or "accession," and might include multiple specimens from the same surgical session. For non-Medicare payers, you might bill multiple units of 88321 or
88323 if the referral involves two accessions from two separate operative sessions or dates of service.

You can bill only one unit of service for 88321-88325 if Medicare is the payer. That's because "CMS payment policy allows only one unit of service for CPTR codes 88321, 88323, and 88325 per beneficiary per provider on a single date of service," according to the CCI Policy Manual.

It appears that your last example involves two separate accessions (slides from different labs, probably from different dates of service). If that's the case, you could bill 88321 x 2 for some non-Medicare payers.

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