Re: cpt consult

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From:Don Hammer <>
To:Janice Mahoney <>
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Hi Jan,

This can get pretty complicated.  :(

If memory serves me right, 88323 is the CPT code for consults.  If so, it is
meant to be just for slide review.  There is no technical component as the
CPT designers overlooked several  things.  In my former institution, I cost
accounted staff time for accessioning, tracking down unfurnished things,
such as, billing info, addresses and UPIN #'s, computer usage,
transcription, report generation (supplies, mailing, equipment depreciation)
returning the slides, storing additional preparations, coding, handling
phone calls to Pathologists/Residents and office staff regarding diagnosis
and/or status, etc.  This cost accounting amounted to around $35.00 a few
years ago.  This cost should be passed on to the Private Pathology Group you
serve.  You can easily see by multiplication, how quickly your resources
(paid by your institution) can be used up and cannot be justified by
increased revenue in your revenue center.

As far as further preparations such as, additional H & E's, IHC, Specials,
Flow Cytometry, Molecular Pathology, and on and on, the Technical Component
can be charged to the submitting institution, providing the Pathologist has
written orders from them, or to the Patient Insurance Company.   This, in
itself, is a nightmare as the Patient usually has no idea the consult was
requested and much time and money is spent in calls to you or the billing
department trying to assure the patient that a consult was obtained when
they insist "I have never been to your Hospital".  (additional hidden costs
to your institution)

The Pathologists can charge for their diagnosis.  In both instances, be sure
the final report states the findings of such additional testing or the payor
can and probably will deny payment.  Lots of teamwork and follow up is
needed to cover all the bases.

Histonetters, please correct me if I am wrong, if correct, please concur to
give Jan the security she needs to handle this.

Don Hammer, Retired Guy
P.S.This should not be construed as "Gospel" nor used to defend your
practices in an Audit.
It is simply an opinion on a very complicated billing situation.   How's
that for covering my butt and retirement funds?  *Grin*
P.P.S. Great seeing you last week!!!

----- Original Message -----
From: Janice Mahoney <>
To: <>
Sent: Tuesday, May 30, 2000 1:44 PM
Subject: cpt consult

> Can anyone give me information regarding technical billing aspects on
consults.  The situation is that Our Pathologists are a separate business
and bill for the professional component separately.  We have begun to do
more and more slide preparation, special stains and immuno on outside
consults.  Can we separate out the technical aspects of the work done and
bill the physician sending the work to us?  If so, do we use the cpt codes
for each individual test(stain, immuno etc.) done, or just charge the
technical component of 88323.
> Thanks for the help
> Jan Mahoney, Omaha, NE

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