[Histonet] RE: Billing for Surgical Pathology

[Weems, Joyce]

This is my understanding..

I think it is meant for clinical tests, but is used for AP also. You have to use modifier 91 for each specimen in addition to the first one removed on the same day.  Part A would be 88305, the others would be 88305-91 so that multiples of the same CPT code can be billed. 

Here is a web site that has info. It is from 2007, but still relevant, I think.

http://health-information.advanceweb.com/article/brush-up-on-cpthcpcs-modifiers.aspx  

And it's description  of 91 

'Modifier -91 is appended to repeat clinical diagnostic laboratory tests performed on the same date. Modifier -91 is not to be used for procedures repeated to verify results or due to equipment failure or specimen inadequacy. If the same test was performed on different sites, use modifier -59 instead. For example, if two wound cultures were taken from two different wound sites, modifier -59 would be appended to the second wound culture code. However, if a second culture was taken of the same wound site, then it would be appropriate to append modifier -91 to the second wound culture code. If a lab panel is performed and one of the tests within the panel is repeated, modifier -91 is appended to the repeat lab test. "

Have a great weekend everyone!! j

Joyce Weems 
Pathology Manager 
Saint Joseph's Hospital 
5665 Peachtree Dunwoody Rd NE 
Atlanta, GA 30342 
678-843-7376 - Phone 
678-843-7831 - Fax 


-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Vickroy, Jim
Sent: Friday, October 21, 2011 17:33
To: histonet <@t> lists.utsouthwestern.edu
Subject: [Histonet] Billing for Surgical Pathology


Billing question -   I have read and understand the CPT codes for surgical pathology specimens including bundling, etc.   I also understand that we can bill a CPT code for each separate specimen. (I know there may be exceptions.)

What I don't clearly understand is the "Modifier" side of all of this.   Example:

Let's say we have four gi biopsies (asc. Colon bx, desc colon bs, esophageal bx, and a rectal bx.
In our system we would enter 4 - 88305's.   Where the argument and question has come is that do we have to add a modifier to these specimens since there are multiple specimens?

Some sources we have say that since they are separately submitted specimens that a modifier is not needed.  Someone else today said that the first of the four specimens does not need a modifier but the remaining four do.

Can anyone shed some light on this?   We have counted on our billing department to be the specialists on this stuff but now that is in question.

Jim

James Vickroy BS, HT(ASCP)

Surgical  and Autopsy Pathology Technical Supervisor Memorial Medical Center
217-788-4046


________________________________
This message (including any attachments) contains confidential information intended for a specific individual and purpose, and is protected by law. If you are not the intended recipient, you should delete this message. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited.
_______________________________________________
Histonet mailing list
Histonet <@t> lists.utsouthwestern.edu
http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Confidentiality Notice:
This e-mail, including any attachments is the 
property of Catholic Health East and is intended 
for the sole use of the intended recipient(s).  
It may contain information that is privileged and 
confidential.  Any unauthorized review, use,
disclosure, or distribution is prohibited. If you are 
not the intended recipient, please delete this message, and 
reply to the sender regarding the error in a separate email.