Linda

This is the sort of thing that makes us tear our hair out. If a group of
specimens comes in three containers, charge three times. If exactly the
same specimens come in one container, charge one time. Doesn't make much
sense does it?

I feel cases should be charged by the procedure, and extra charges
tacked on for extra work done (more blocks, more specials, immunos,
etc.) That's the only way to be accurate as well as fair. Billing is
still in the dark ages, and the public would be astounded at the
discrepancies that abound in the lab.


Tim Morken, B.S., EMT(MSA), HTL(ASCP)
Infectious Disease Pathology
Centers for Disease Control
MS-G32
1600 Clifton Rd.
Atlanta, GA 30333
USA

email: tim9@cdc.gov
       timcdc@hotmail.com

FAX:  (404)639-3043

----Original Message Follows----
Date: Mon, 12 Oct 1998 14:39:16 -0500
From: LINDA MARGRAF MD <LMARGRAF@childmed.dallas.tx.us>
Subject: Re: Charges for multiple tissues
To: HistoNet@Pathology.swmed.edu, pdelvent@wyoming.com

Dear Pricilla:
I oversee the billing for our group of pathologists (and histology) and
keep handy an old (1991) College of American Pathologist's Manual which
covers the  American Medical Association recommendations for CPT billing
in anatomic and clinical pathology  (as well as a copy of the AMA's
1998 CPT manual ). These answer most of your questions about what is
allowed though you can, I believe,  bill for lesser amounts if you wish.
The unit of service is the specimen and if multiple ones are submitted
you can bill the same amount multiple times. (I agree it can add up fast
so we have limits on how many we will charge for).  For tonsils and
adenoids, if they come in three containers, you can bill for three
specimens (88300x3 if the pathologist  does gross only,  88304x3 if
gross and micro is done on each specimen). If you get two skin lesions
in one container and they aren't separately designated you can bill just
once. If one has a suture to designate its site as different from the
other you can bill for two specimens. Uterus with/without tubes and
ovaries (all in one container) is 88307 (non-neoplastic) or 88309
(neoplastic). I expect if they sent the ovaries in separate containers
you could charge separately for them (I'd check to see why they came
that way before I made a decision).  I think it is hard to do accurate
billing without knowledge of the diagnosis in many cases and prefer to
assign the c!
odes myself after the cases have b
een done rather than to have the technologists try to guess in advance.
The coding system is designed to reflect physician work  for each
specimen which unfortunately doesn't reflect the amount of  technologist
work very well.  I believe it is the system the government expects us to
use when they come to inspect everyone for fraud and abuse though so
being sure to be accurate and consistent in your billing practice is
certainly a worthwile endeavor.
Linda Margraf
Associate Professor of Pathology
University of Texas Southwestern Medical Center
and
Histonet administrator (in my diminshing "spare" time)

>>> Priscilla <pdelvent@wyoming.com> 10/10 7:19 AM >>>
Hi everyone in Histo Land--We are having a discussion about making a
special charge for specimens that arrive in multiple for processing.
Things like more than one skin specimen, colon bxs, prostate needle bxs,
etc.  In the past I have always had a charge of XXX multiple where I
lower
the price of the single specimen and then times it the number of
specimens
that have been removed and called it skin multiple or prostate multiple
or
colon multiple.  These would all be submitted in separate containers and
thusly separate cassettes.  The colon bxs especially can amount to more
dollars charge than to remove the whole colon if the single specimen
charge
would be multiplied times the number of sites bxs.

How do you handle these charges?

Also in researching these charges by calling other hospitals, I came
across
another interesting method of charging.  I have found where even if a
bilateral specimen such as vas deferens or fallopian tubes were
submitted
in the same container  (Yes, I too, hope that there is a suture on the
right sided specimen to denote which it is) that the charge was x two
even
though it was submitted in the same container.  Interestingly enough, I
have always submitted only one charge for a bilateral fallopian tube or
vas
deferens, even if they were submitted in separate containers (which I
hope
they were)

Also in the case of uterus, fallopian tubes and ovaries, I found where
there were three charges even though the specimen was submitted in one
container.  For Tonsils and Adenoids, I found places charging 3 charges
for
this type of specimen.  I have always charged only one charge for either
both tonsils or tonsils and adenoids.

Either I have been very stupid or just not up to date on charging
practices.  I'm sure our patients hope that I don't become too informed
as
changing the way I've been charging will make a big impact on our
customers
bills.

Does any one know of rules for this?  I always thought that anything
sent
down in a separate container needed a separate charge, except in the
case
of bilateral specimens such as those mentioned above, and I thought that
T&A's were submitted separately just so the specimen could be identified
as
to the proper side,  I also thought that UTO's were considered one
specimen.  I can see where a uterus sent separately from the ovaries
could
justify a separate charge, especially if one ovary was possibly
neoplastic
or the uterus was and the ovaries benign.  Of course we don't know until
the microscopic, do we?

I look forward to being enlightened by this group.  Please be kind to
me!!
I'm usually on top of these things, but coding workshops usually are for
the total billing and I don't get sent to them if they don't concentrate
on
just Pathology.

Priscilla in Central Wyoming



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