Healthcare Fraud Shield's Coding Q&A
Healthcare Fraud Shield's Subject Matter Experts receive many emails throughout the year containing questions regarding FWA, coding and more. Healthcare Fraud Shield is dedicated to sharing information in the FWA field. As a result, below are some recent questions along with the answers shared with some of our readers:
Question:
Can a provider bill multiple units of CPT 75898 (Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other than for thrombolysis)[1]?
Answer:
The MUE limit on CPT 75898 is 1. To be able to bill multiple units, the provider would need to perform separate follow up studies. In addition, I would also expect you would see the -76 modifier attached.
Questions or comments? Please feel free to contact Healthcare Fraud Shield's Subject Matter Experts at SIU@hcfraudshield.com for more information.
Question:
How many units of CPT 88321 (Consultation and report on referred slides prepared elsewhere)[2] can a provider bill and how multiple units can be billed? I have some providers billing per specimen and some per date collected.
Answer:
Great question. According to the AAPC Coding Tool-AAPC Coder[3], a qualified provider, typically a pathologist, receives a consultation request and prepared slides from another location that he/she reviews as part of a consultation. A consultation request can come from another pathologist, surgeon, or other clinician. The consulting provider may review multiple slide types, such as cytology or tissue slides, from different body areas that count as one surgical pathology case. After a thorough examination of the slides, he prepares a report detailing his evaluation and opinion.
In other words, the report can be on one (1) or multiple slide types, and from one or more body areas -- but the bottom line the billing is "1", as in one (1) surgical pathology case. There should also be a detailed report of the findings. So to answer your question, one (1) report/ DOS. Unlike most other surgical pathology codes, the specimen is not the unit of service for 88321 to 88325. The surgical case is the unit of service.
**Be sure to check payer policies before reporting this code. Some payers may limit you to reporting 88321 once per patient per day even when the provider consults on more than one surgical case.
REFERENCES:
[1,2,3] AAPC Coder
Questions or comments? Please feel free to contact Healthcare Fraud Shield's Subject Matter Experts at SIU@hcfraudshield.com for more information.