In Australia Charges are controlled by legislation as may well be the case
elsewhere. We are only able to charge for a single surgical procedure
irrespective of how many might be performed on the same day eg. a
Gallbladder and skin biopsy would be only a single charge, as would be the
case say for five different skin biopsy sites performed either at the same
time or on the same day. In these situations we loose money esp. with
multiple endoscopic biopsies; however we do have provision to charge for
various levels of special stains incl. Peroxidase's- but in these instances
you have to rely on a third party usually the pathologist to let the
accounting staff know that these extras have been performed, so that the
extras can be added on- so that more often than not they are still missed.
The real bread and butter cases are the outpatient services where you
usually only get a single biospy and usually only require a H&E; here
General Surgical Path. Labs have it pretty tough financially.
There is also the Option we might charge more than the basic fee, but in
doing so you invite loosing buisiness to your competitors.
Regards, Mike Rentsch
-----Original Message-----
From: Priscilla <pdelvent@wyoming.com>
To: HistoNet@Pathology.swmed.edu <HistoNet@Pathology.swmed.edu>
Date: Sunday, 11 October 1998 4:20
Subject: Charges for multiple tissues


>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
>