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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