Re: Charging immunos

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From:"Don Hammer" <> (by way of histonet)
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You can charge one antibody per "specimen".....example, specimen A or 1 or
whatever you may label it,  may be charged for each antibody you do.  Not
slides but per antibody.  Specimen B or 2 or whatever, may be charged for
the same antibody, if done, but not per slide,  and so on.

Some feel there is a cap on the amount of antibodies you are able to bill.
There may be, and maybe not, depending on the insurance carrier.  I would
suggest billing for each antibody on each specimen and leaving the carriers
to deny any over their particular cap, if they have one.

In other words, you cannot charge more than once per antibody, per specimen,
no matter how many slides you do for the particular antibody on the same

The same situation holds true for special stains.

There are some tricky ways of identifying specimens, but that is a whole
other bag of worms.  Until you are sure of how specimens may or may not be
split,  use the rule, one specimen per container as submitted.  I would
suggest finding out what specimens submitted in one bottle may constitute
more than one (allows for proper billing and proper recovery)  and
conversely, specimens submitted in separate containers constitute one. ( if
you do this wrong, it may be considered Fraud)  Following thru with these
rules will only add to your expense of teaching everyone how to separate or
un-separate them and complicate your tracking system as well, but you have
no choice.

Facetiously, what a wonderful world of billing Medicare has set up to save
costs.  Damn, if you add up the costs of figuring out how to do it, coding,
billing department expenses, dealing with rejected bills, answering patient
questions, hiring consultants to assist in doing things correctly, writing
involved procedures, training your staff, making them aware of how to
"whistleblow" if they see something they feel is done wrong or have a grudge
to deal with, one may question if the payment has even touched covering the
cost of doing the test!   Then there is the added expense of being fined for
fraud because you did not  UNDERSTAND the rules, let alone know them, and
doing something wrong.  (not knowing is Fraud in Medicare's eyes)

Of course during all this, you must lower your costs to perform the
diagnostic tests to stay in business.  Unfortunately, it seems, no one in
the rule making body has worked in a lab.  Compound the costs in the lab to
the entire Hospital and you will see enormous costs to cover expenses.
Where is Health Care going?  Great technology but no one wants to pay for

A major reason I am,
Don Hammer, Retired Guy
(Thank God for the stock market)  *grin*   (I am a few years from Medicare
coverage and plan to keep up on the changes invoked until then.)  What a
mess Healthcare is in!

----- Original Message -----
From: Donna Sitrin <>
To: <>
Sent: Thursday, November 18, 1999 4:27 PM
Subject: Charging immunos

> Does anyone know if a CPT charge can be generated per slide, or per
> antibody?
> Thanks for your input,
> Donna Sitrin
> Unipath, LLC

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