[Histonet] Billing question

[Julia Dahl]

Brandi -

The practice of ordering stains "from the bench" in which a special stain is 
routinely performed on ALL of certain types of specimens is a practice that 
is frequently performed for the convenience of the laboratory (habits and 
routines MAY build efficiency) and to reduce turnaround time.  In many of 
these specimens, there are not histologic features on the H&E that would 
prompt a pathologist to order the giemsa (or other stain).

To date, I have not heard of any ruling that does not allow a 
pathologist/hospital to bill for NECESSARY special stains.  However, there 
is a great deal of inquiry about whether or not practices are billing for 
unnecessary stains.  This could be what the billing consultant is referring 
to.

In your instance you could:
- Continue to perform the Giemsas on all gastric and esophageal biopsies 
(I'm assuming you mean GEJ where there is gastric mucosa?) but only bill for 
those stains that are INDICATED and REVIEWED   because the H&E findings 
would prompt a giemsa stain.
- Discontinue performing Giemsas on ALL gastric and esophageal biopsies and 
perform Giemsas (or another Group I 88312 or H. pylori immuno (88342) on 
ONLY those cases in which the stain is indicated by the H&E findings.

To appropriately bill for an 88312 - the test should be BOTH indicated and 
reviewed by the pathologist.  A giemsa or H.pylori immuno on a fundic gland 
polyp is generally NOT indicated (unless there is a great deal of chronic 
and active inflammation) and billing for an unnecessary test - even if the 
pathologist reviewed the Giemsa is a risky practice.  Not to mention a 
questionable use of medical dollars.

Julia Dahl MD
Mosaic Gastrointestinal Research Consortium


>From: "Brandi Farris" <Brandiwork <@t> mchsi.com>
>To: <histonet <@t> lists.utsouthwestern.edu>
>Subject: [Histonet] Billing question
>Date: Wed, 6 Sep 2006 20:13:01 -0500
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>Hello,
>
>Our hospital recently had an insurance/billing consultant give us some 
>advice. We currently perform and bill for a giemsa stain (special stain 
>group I) on all stomach and esophagus biopsy specimens. The consultant told 
>us that we could no longer bill for those. What stain is everyone else 
>doing and how are you billing it?
>
>Thanks
>Brandi Farris
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