You bill the extra units of 88341 on additional lines, up to 9 per line, and add modifier 59 to the extra lines. So I am going to assume you have 20 total IHC single antibody stains and just aren't including the first one (charged as 88342x1) in this question leaving you with the 19 additional stains.
Full Answer
Does 88341 require the 59 modifier when billed with 88360?
yes, Per NCCI edits, 88341 does require the 59 modifier when billed with the 88360... You must log in or register to reply here.
Do they pay for 88342 or 88341?
They will pay the 88342, but deny the 88341 saying either because 1. based on industry standards, this service does not require pc/tc components (False!) or a provider of this specialty does not perform this service (False!). It's really frustrating as their suggestion is to just do an appeal.
What is the correct way to submit Form 88342?
We had gone through the same issue in the past. 88342 is Medicare adjudicator indicator MAI of 3, which is a claim line item. So for example if 88342 has quantity/units of 5, the correct way to submit is Make sure 88342 is submitted as 2 separate claim lines in the UB.
What does the IHC code 88342 mean?
88342 is the initial stain per specimen. It's for the initial (i.e., first) IHC stain applied per specimen. Additional IHC stains for each specimen are coded as 88341. Note: The codes are out of sequence numerically.
Does Medicare pay for 88341?
3. Medicare does not pay for duplicate testing. Immunocytochemistry (e.g., CPT codes 88342, 88341, 88344, 88360, 88361) and flow cytometry (e.g., CPT codes 88184-88189) should generally not be reported for the same or similar specimens.
Does CPT code 88341 need a modifier?
You bill the extra units of 88341 on additional lines, up to 9 per line, and add modifier 59 to the extra lines.
How do you code 88341?
Add-on CPT code 88341 would be used for each additional single probe stain procedure per specimen. When multiple separately identifiable antibodies are applied to the same specimen (i.e., multiplex antibody stain procedure), use one unit of 88344.
Does Medicare pay for flow cytometry?
Claims for Flow Cytometry services are payable under Medicare Part B in the following places of service: For CPT codes 86355, 86356, 86357, 86359, 86360 and 86361: office (11), independent clinic (49), federally qualified health center (50), rural health clinic (72), and independent laboratory (81);
What does 59 modifier mean for Medicare?
Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances.
What is the difference between 88341 and 88342?
Code 88342 should be used for the first single antibody procedure and is reimbursed as one unit only. Code 88341 should be used for each additional single antibody for each specimen, and is reimbursed up to a maximum of 9 units.
Can 88341 and 88360 be billed together?
CPTs 88342 & 88341 require a modifier to be billed with 88360. You should add modifier 59 if billing a commercial carrier or modifier 59 or XU if billing to Medicare.
Does Medicare pay for 88342?
While the pathologist may choose to confirm a suspicious focus in one or more cores in a case where the diagnosis of cancer has already been made, it is not a Medicare covered service because it provides no additional actionable information to the treating physician.
How do you code immunohistochemistry?
The CPT Editorial Panel revised the existing immunohistochemistry code, CPT code 88342 and created a new add- on code 88343 for CY 2014.
What is the CPT code for peripheral blood flow cytometry?
CPT Code(s): 85060 Peripheral blood review.
Is CPT 88185 an add on code?
There are two codes to report the technical side, the work done to prepare the specimen and run the test, 88184 and add-on code 88185.
What is the CPT code for cell count body fluid?
89051CPT® Code 89051 in section: Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, joint fluid), except blood.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
This Billing and Coding Article provides billing and coding guidance for molecular pathology services, genomic sequencing procedures and other multianalyte assays, multianalyte assays with algorithmic analyses, and applicable proprietary laboratory analyses codes and Tier 1 and Tier 2 molecular pathology procedures.
ICD-10-CM Codes that Support Medical Necessity
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Title XVIII of the Social Security Act, §1833 (e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.
Article Guidance
The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Lab: Special Histochemical Stains and Immunohistochemical Stains L36351.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
General Information
CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
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Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
CMS Internet-Only Manual, Pub 100-02, Chapter 15, §50.4.1 Approved Use of Drug and §50.4.5 Off Label Use of Anti-Cancer Drugs and Biologicals
Article Guidance
The purpose of this article is to provide billing guidance for chemotherapeutic agents, that are usually billed as “incident to” medications under Part B.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
