Re: CPT coding/billing

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Sheila Tapper asks:

<<How do your institutions handle multiple specimens? If the dermatologist 
removes 6 separate lesions, are all 6 specimens billed? Are they billed at 
the same price? Do you "cap" the pricing at any time? Do you use modifiers? 
If you are using modifiers for multiple specimens, which one do you use?>>

If the separate lesions are identified as to site and signed out separately,=20
they get a separate 88305 or whatever. I know that many practices have 
formulas for reducing charges - for example, ten specimens may be reduced to=20
five 88305's, but pathologists are very reluctant to talk about how they do 

Is your pathologist involved in the coding? This is very important - you 
should not have the sole responsibility. Particularly to be avoided is the 
custom of doing the CPT coding before the microscopic examination, since a 
number of coding situations depend on the microscopic diagnosis. I think it's 
always best to have two coders - one coder inevitably misses some codes that=20
the other catches.

An important update on this was published in CAP Today, July 1999 (look in 
the pile of them in your pathologist's office.) I took these notes at the 

Carl Graziano, CAP manager of government communications and Washington 
editor, quoting Stephen N. Bauer MD who is the chair of the CAP Professional=20
and Economic Affairs Committee PEAC) and represents the CAP on the AMAs CPT 
Advisory Committee.

Skin bumps get multiple 88305s if they can be identified and signed out as 
separate specimens, even if received in the same container.

An unusually difficult or time-consuming case can have the added modifier 
-22, Unusual Procedural Services, though many carriers do not recognize it.

Bob Richmond
Samurai Pathologist
Knoxville TN

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