[Histonet] CPT Coding question 88342 PIN 4 cocktail

[Della Speranza, Vinnie]

Disclaimer: I do not consider myself to be a coding expert. Take my opinions with a grain of salt.

I've never seen coding for softening of keratin therefore I don't see how you could charge for it. This is not decalcification and should not be represented as such. Until such time as a code appears (don't hold your breath) the KOH or whatever technique you employ is for your convenience to make a block more cuttable (is that a word?).

There is no rule that technical and professional charges must be the same. They are reimbursed differently, sometimes the technical having a higher reimbursement than the professional. You are free to set your charges for each where you see fit.

I believe that your charges for prostate IHC have to be justified by the pathology. In your example, some of those cores may be clearly benign and there would be no basis for charging IHC for eight cores if only one or two contain the lesion. In your case, by having four cores in one block, you benefit by keeping your expenses down however I do believe that your IHC charges should (must?) be based on the location of the lesion under study. It would seem to me that charging for IHC on eight cores when the report describes a lesion in only one is asking for trouble 

You are correct that you can charge 88342 x 3 for the PIN 4 markers as each is separate and can be visualized distinctly from one another.



Vinnie Della Speranza
Manager for Anatomic Pathology Services
Medical University of South Carolina
165 Ashley Avenue  Suite 309
Charleston, South Carolina 29425
Tel: (843) 792-6353
Fax: (843) 792-8974
 

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Shea's
Sent: Tuesday, March 10, 2009 9:09 PM
To: histonet <@t> lists.utsouthwestern.edu
Subject: [Histonet] CPT Coding question 88342 PIN 4 cocktail

We started staining prostate needle bxs w/ PIN 4 (triple stain). 
1. My understanding is that we can bill for 88342 x 3 (per specimen) if a comment is made on the results of the nuclear staining and cytoplasmic staining of the DAB and the staining of the Vulcan red. The key is documentation in the report. This is simple to understand when you rec'd 1 specimen/container, but we rec'd:

A. Right prostate Bx - Red stained bx: apex
                                 Green stained bx: base
                                 Blue stained bx: midgland
                                 Yellow stained bx: transition
submitted in one Cassette A.

B. Left  prostate Bx - Red stained bx: apex
                                 Green stained bx: base
                                 Blue stained bx: midgland
                                 Yellow stained bx: transition
submitted in one Cassette B.

2. If the pathologist needed  this stain on every specimen, it would be 8 separate identifiable specimens x 3 (separate identifiable stains in the cocktail) , therefore            88342  x 24, even though it is only 2 blocks.

3. If the pathologist was only interested in this stain on on the Apex in A and B it would be 2 specimens x 3, therefore 88342 x 6 for the same 2 blocks (even though it stains all 8 specimens, only 2 of the 8 are in need of this stain).

   Another words, we can't charge the technical component until we find out how many specimens the pathologist is looking at in a slide (professional component), even though it is the same amount of work and reagents.  Does this sound right?

4. Is the technical charge always the same as the professional charge?


Another unrelated question - We can bill for decalcification, but is there a billing code for  KOH in the same manner to soften and treat toenails before processing? It is documented in the Path report.
I know this has been discussed in the archives, but there seems to be conflicting opinions. Do we know for sure?
Thanks


_______________________________________________
Histonet mailing list
Histonet <@t> lists.utsouthwestern.edu
http://lists.utsouthwestern.edu/mailman/listinfo/histonet