Re: Charges for multiple tissues

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From:"D. Hammer" <> (by way of histonet)
To:histonet <>
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Hi Linda,

I would add to your excellent explanation that:  If multiple specimens are
recieved in one container, unmarked by suture or something, BUT the
request form designates different sites, then all the specimens may be
charged seperately.  Of course, this needs to be dictated in the report
and the requisition kept for auditing.

CAP's past recomendation for keeping these has been 2 years, which we have
been following.  However, recently we have been told Medicare can audit 7
years back, so we have changed our retention timeline. (thus adding one
more additional cost of providing healthcare, due to costly storage space
and the hands that do the storing.) I'm not sure if CAP has changed their
reccomendation to upgrade for "fraud audits"

Don P.S.  I wonder if any one in the regulation arena realizes how much
hospitals spend trying to satisfy all the regs.  I feel there are regs.
which are needed, but having gone thru many CAP, JCAHO, DOH and whatever
inspections, I'm a little weary of "show and tell"  Just imagine how much
money (patient dollars) is spent on "storyboards" "slick manuels" (most
use working ones), Coding FTE's, QA department FTE's, Billing dept. FTE's,
making sure everyone on staff knows how the billing works, when we can
hardly keep up with how convoluted it is now, Complience Officers, time
spent on trying to interpet survey monitors and figure out how inspectors
will interpet the monitor (see recent discussion on IHC controls) and on
and on.  All added expenses over the years while trying to keep the prices
down and TAT (turn-around-time) faster.  Guess I better stop, my P.S. is
getting longer than my message :)

Don Hammer, Administrative Director            UNIVERSITY OF WASHINGTON
Hospital Pathology, Box 356100                     MEDICAL CENTER
1995 NE Pacific St.
Seattle Washington, 98195                  ~Where Knowledge Comes To Life~
(206) 548-6401 Fax: (206) 548-4928

On Mon, 12 Oct 1998, LINDA MARGRAF MD wrote:

> 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!
> 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 <> 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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