Table of Contents
Does CPT 88342 need a modifier?
If you billed it global 88342 with no modifier you will receive full reimbursement. However if your team is like mine counting on RVU’s for the work they performed; then you would bill each 88342 with the appropriate 26 or TC modifier so each provider receives their entitled RVU’s.
Does CPT code 88305 require a modifier?
The cell block and biopsy are billed separately as 88305. Modifier -59 is required to indicate that different levels of service were provided for different specimens. Modifier -59 is also appropriate when performing the same procedure for a different specimen that uses the same CPT code.
Who can bill CPT code 88305?
88305 is for the gross and microscopic examination of a specimen to provide a diagnosis. This is the code the pathologist uses to describe their work value on this specimen. The family practice would bill for the procedure obtaining the specimen.
Can CPT code 45385 and 45380 be billed together?
If you removed some and then biopsied other areas then yes you can bill together with a modifier.
When is CPT code 88305 not eligible for reimbursement?
When CPT code 88305 is reported in excess of nine units on the same date of service with a prostate diagnosis, the code will not be eligible for reimbursement. Effective September 1, 2012, the global reimbursement for professional pathology services for prostate biopsy codes 88305 and 88307 will be capped at nine units.
When to use CPT code 88305 for prostate needle biopsy?
When the tissue samples are for prostate tissue, HCPCS lists procedure codes G0416-G0419 for 10 or more specimens in various increments for prostate needle biopsy. Therefore, the Health Plan will apply a frequency limit of nine units per date of service for CPT code 88305 when reported with a prostate diagnosis.
When do IHC codes 88341 and 88342 apply?
(Author’s note: The fact that code 88341 follows 88342 in the preceding list is not a typographical error. The codes are out of numerical sequence in the official AMA codebook.) Codes 88341 and 88342 apply when a pathologist reports an IHC stain using qualitative expression.
What do service codes 88300 and 88304 mean?
Service code 88300 is used for any specimen that in the opinion of the examining pathologist can be accurately diagnosed without microscopic examination. Service codes 88304 through 88309 describe all other specimens requiring gross and microscopic examination, and represent additional ascending levels of physician work.