Re: CPT coding/billing

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Hello Diana,

In a message dated 07/13/2000 9:37:04 AM Pacific Daylight Time, writes:

> Is there a way to charge on a per-block basis, rather than just 88300-88309 
> time for each case?  

The unit of service for coding is the specimen.    

>  For example, under code 88305, both needle bx. of prostate, 2-3 blocks, 
>  prostate-TUR, 10-15 blocks are  listed.  Obviously, the TUR takes 3 times 
>  equipment, supplies, and tech-time to process.  

I have a question.  How are you getting 2-3 blocks on a prostate needle 
biopsy?  Is there an abundance of tissue or are there multiple separately 
identified biopsies?  If the later is the case, each of these separately 
identified, reported biopsies should get it's own 88305.

Note:  Prostate, TUR is coded 88305 but Urinary Bladder, TUR is coded 88307.  
>  Also, are there appropriate codes for serial sections and re-cuts?
No.  (Sorry)

All is not doom and gloom, however.  Use of modifier -22 (Unusual Procedural 
Services) may be appropriate if the excess amount of work is sufficiently 
documented in the report.  

Additional reimbursement will probably depend on how convincing your 
documentation of the additional work performed is explained in the report as 
well as your negotiating skills with the payor.  

No additional reimbursement should be expected from Medicare.

Let me know if you need more info.

Matt Bowers
Lab Manager
Visalia Pathology Medical Group
126 South Floral St. 
Visalia, CA  93291

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