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    Wiki In search of an LABORATORY coding mentor!

    I am a little unsure here how to respond. Laboratory is pretty cut and dry here. The accessioner or cytotech dropped a charge. Are you going to validate it or trust what CPT they gave you? I'm seriously wondering why you would review a laboratory test here unless a clinician reviewed it at the...
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    Wiki Respiratory Viral Panel

    You are accurate chels1918 Medicare in an outpatient setting will not cover this charge; does your healthcare facility know how to complete an ABN? You can find that information on the CMS.gov website to help. This was the link I found and stated 2024...
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    Wiki Provider Signature

    Hello quizon.marie12@gmail.com, May I ask a question please? What do you believe is the difference between an actual signature (possibly a scanned in "order" document) versus an electronic signature? Those requirements for our clinicians to log in and provide an electronic signature (those...
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    Wiki 88360

    You are absolutely correct Narobo. Please be cognizant, not everyone has access to the APF manual here. Explain it in simple terms.
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    Wiki 88360

    Hello Narobo, I will bill 88360 if tumor cells were quantified. I will appeal charges all day long. You need the numerical value %, <, >, or = to 1, 2, 3 with the disclaimer (key) on why; or possibly greater than 90%, 80%, 20% or otherwise to support billing this. It has to be quantified and I...
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    Wiki CYTOLOGY 88112/88313

    Yes TGRAY, You are absolutely accurate. The pathology report does not state exactly why the Wright smear was evaluated. No mention of why it was performed or any mention of positive or negative results. I would have not billed it. That is exactly why I stated, "if documentation supports it to...
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    Wiki Newbie with breast biopsy question

    Yes, MrsSpiney I did not mean to alarm you from my prior comment. I am betting that all charges warrant the 88307 because margins were reviewed here. I thought we were reviewing CPT not ICD here and I wholeheartedly apologize. No worries, we are reviewing ICD, let's go "to the basics" here...
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    Wiki Newbie with breast biopsy question

    Hello and good evening MrsSpiney, I do not care if the margins were on fire here. Seriously, what did the pathologist state within the pathology report that I do not have the privilege to see? Did you carefully access the "gross for inking and blocks" and did you also "carefully access the...
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    Wiki 88360

    sdaniels ~ you nailed it! you have the coding spot on! If anyone else was wondering why I state that. First, Let's look at the body of pathology report. We all know AE1/AE3, GATA3, ER, PR and HER2 were performed. Seriously, look at the rest of the pathology report to support those charges...
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    Wiki PERIPHERAL SMEARS

    I wholeheartedly apologize Lupita1983 I did not need to even look at your example in an outpatient setting. 85060 is denied all day long by CMS. It is deemed an inpatient only specimen. If it is commercial you may get reimbursed. Maybe it is time to explain why an outpatient 85060 is medically...
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    Wiki FLOW PROFEESIONAL 88187-88189

    Hello raphaguz@yahoo.com, There were two distinct billing scenarios. I would ABSOLUTELY NEVER COMBINE TWO BILLING SCENARIOS TO DRIVE CPT CHARGES (either professional or technical). The Flow Cytometry 88189 was performed. Same day the PNH interpretation was performed. You need to apply the...
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    Wiki intestinal metaplasia vs barrett's esophagus

    Hello Morella1, Let me see if I can help provide some help with Barrett's Esophagus AKA intestinal metaplasia. If you refer to your ICD book on Barrett's Esophagus, it directs you to utilize the default K22.70 (any mention of dysplasia; there are subcategories to review in your ICD Index)...
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    Wiki Where is the AAPC in all that Love and union for discission making these discussions; I'm probably a jerk have my feedback but to just shut up here.

    I'm going to post here.
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    Wiki Pathology coding production standard

    I'll reply here kozy I clearly believe the radiology department took on pathology here (tell me I am wrong). Average production isn't based on CPT assignment here. It is 20-25 pathology accessions per an hour (mixture of simple and complex accessions for review) Just curious, have you ever had...
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    Wiki Path consult 88325 vs 88321

    Hello pinky72034@aol.com Please don't post multiple times for same scenario. I posted on your original post (deleted it) to post on your most recent post. Yes, just reviewing the slides along with the pathology report from an outside facility requesting a consultation, warrants billing 88321...
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    Wiki CYTOLOGY 88112/88313

    Hello Lupita1983, I have reviewed the information and the APF Pathology Manual with you billing all three charges if documentation supports it. I do not have access to the pathology report, only what you provided. If you reviewed the APF manual, have all the qualifying factors to support it...
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    Wiki Pathologist Presentation (Coder has a question about the pathology report and the pathologist will help)

    https://us02web.zoom.us/meeting/register/tZMvf-6tpjIjEtyUawm-oPDebs4R-36T1eIW Super gracious and courteous of Colorado Springs, CO for hosting this presentation because on 3/19/2024 Pathologist, Dr. Dianne Kendall is doing a “meet with the coders”. ABSOLUTELY PHENOMENAL!! 3/19/2024 at 6 PM MST...
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    Wiki Toenail testing for fungus onychomycosis

    Hello Valley1, No, so sorry there nothing on my calendar for presenting pathology. If that changes, I'll post it. Thank you for inquiring, Dana
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    Wiki Phyllodes tumor, low-grade

    Hello annettebec, From your statement "phyllodes tumor - low grade" diagnosis assignment. First it is very important to go to the Index portion of your ICD-10-CM book and locate the term "Tumor". Next, you need to carefully review all the subheadings in alphabetical order under the term...
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    Wiki DX help

    Hello ejthornton, I have a question. You stated that the patient tested positive for both. What did the clinician state within their notes? Just because the test came back positive doesn't mean a coder gets to assign the positive result. The clinician needs to review the results and provide...
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    Wiki Dx Code that can't be Primary Code

    Hello wilsonaim2210@gmail.com, I'll comment on this scenario. If a provider (clinician) puts in a lab order with a solo diagnosis code that cannot be billed solo/primary diagnosis code; if you have the ability (this sounds likes it is an internal healthcare issue for you from your example) -...
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    Wiki CPT CODE FOR GIANT CELL TUMOR OF TENDON SHEATH

    Hello sspence, Giant cell tumor of the tendon sheath warrants CPT assignment 88307. This is supported from within my APF pathology manual. I can't share with you the information within the APF manual (copyrighted). However, it does reference the AMA if you or your pathologists have access to...
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    Wiki 87077

    Hello jbirnbaum68@gmail.com, I have a little information to share with you on this. Please review the NCCI manual - link https://www.cms.gov/files/document/medicare-ncci-policy-manual-2024-chapter-10.pdf I'm reviewing page X-4 that states: "CMS policy prohibits separate payment for duplicate...
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    Wiki Toe nail

    Hello Lucy071789, I previously worked a few years back for a little healthcare facility in Central Minnesota that has a laboratory catalog that provided this information. Doesn't your healthcare place have a laboratory catalog you can rely on for your questions here?? What CPT codes are you...
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    Wiki 82784 - Immunoglobulin - Help!

    Hello Sdrivera, 82784 may be billed 6 times before exceeding the MUE. I'm shaking my head here. Why are the quantities misaligned? I read your IgA, IgD, IgG, IgM and saw your example that a total of 5 quantities were billed! First, one unit. second, one unit, and third, three units. Who or...
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    Wiki Screening colonoscopy diagnosis coding for pathology procedure code 88305

    Good evening RobynKing, I have been an advocate in pathology for quite some time. You are accurate. You find a polyp, adenoma of cecum, polyp of rectum that you just code the pathologist's interpretation. There are numerous medical policies out there (AETNA, UHC, Cigna, among others out there)...
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    Wiki Toenail testing for fungus onychomycosis

    I clearly do sympathize with you Lucy071789; You know as a pathology coder things just happen (like mistakes). I am seriously not about to judge. I am more of a let's just get our pathology coders (including me) to a happy place where all the answers are there. I clearly need the AAPC, AHIMA...
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    Wiki Toenail testing for fungus onychomycosis

    No, Lucy071789 Toenail or any nail is CPT 88304 and if stain done that is also billed. I am curious on why you believe that CPT 88305 for excision of toenail is warranted here? Thanks, Dana
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    Wiki 87493 & 87324 guidelines

    Hello Lucy071789, Yes, to answer your question, a modifier is necessary (if appropriate) when billing these two CPTS together on the same day of service. Thanks, Dana
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    Wiki Toenail testing for fungus onychomycosis

    Hello Lucy071789, I believe I know what you are asking. May I provide you with a horribly fictious example on what I believe your question is with my answers please? Clinical Indication: Nail dystrophy Final Diagnosis: A. Nail clipping: Onychomycosis Microscopic: Special Stain PAS for...
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    Wiki coder's specialty guide 2024: Pathology/Laboratory

    Hello Lucy071789, That is a great question. Back in November they had a really fantastic deal on this pathology book set and I was "on the fence" whether or not to purchase or not. I had it in my AAPC cart and the AAPC reached out to me to ask if I needed assistance with my purchase...
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    Wiki J-Pouch with polyp diagnosis help!!

    Hello jodielonkoski, I am reviewing your question and I completely understand and feel your pain here. Polyp of colon K63.5 isn't appropriate, clearly neither is K62.1 (polyp of rectum) or K31.7 (polyp of stomach & duodenum). This is my rationale here. We know that pouchitis occurs for...
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    Wiki Coding soft tissue mass

    Hello jodielonkoski, I'll walk through my rationale if that may assist you. I was an anesthesia coder for many years (also working specifically denials for a satellite) for several years. But I saw your post and lack of (takers) comments and wanted to try to help you this evening. Okay...
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    Wiki 88360

    Hello sdaniels No, there is nothing from your post that has additional immunohistochemical stains. Your post only discusses SOX-10 with PRAME warranting 88342x1, 88341x1. Goodness: that may be a great question to pose to your pathologists though. The reason I simply state that is because I have...
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    Wiki FNA/FNAB - Can you bill 88173 and 88305 if no cell block was created but tissue was submitted

    Unsure why we are dragging stuff out from years ago. It would be your responsibility to make sure that NCCI edits still hold true today Dana
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    Wiki IHC Stains with Mohs

    Hello Roholl, I will try to help you. Please do not post in all "caps" that is like yelling at someone. Sometimes, a phrase in capital letters is appropriate to drive the point, okay. Let's move to issue at hand. Okay your dermatologist/dermpath performs a MOHS and sends the specimen to your...
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    Wiki Laterality denials for path?

    Hello treinemer, No, I don't believe they are looking for laterality here (in my opinion of course). Let me throw out a fictional example here using your CPT codes and no other charges: Pathology department receives Specimen A let's just state it was a skin biopsy (gross and microscopic...
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    Wiki Amputation ICD10

    Hello hbell339@gmail.com, You have a fantastic question! When I was a just a pathology coder, I would have assigned the Z89.422 in addition to the rest of the findings in the pathologist's interpretation. Please, allow me to explain my rationale. First our ICD book states when you refer to...
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    Wiki Why was I marked wrong? (Practicode Case ID: OPD7382)

    Well, if they thought the indication was accurate; N95.0 post menopausal bleeding, I'm not coding the coding the endometrial cells present here, NO that may not be an abnormal finding here. I'll challenge anyone to state otherwise. You throw me your examples please!
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    Wiki Kappa/Lambda ISH single vs multiplex probe?

    Hello SBilb89, Yes, I am. I had to do some digging to find a "free" solid pathology resource that I could reference to assist with answering your question today. This is the file I am referring to is from Medicare NCCI 2023 Coding Policy Manual. The Chapter X Pathology / Laboratory Services...
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    Wiki mastectomy for gender transition

    Hello psnoopy1962@gmail.com, Per our CPT book Breast, Mastectomy - partial/simple warrants the assignment of CPT 88307. Thanks for listening, Dana
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    Wiki Transgender patient

    Hello debdebc, I will assist you with what I know. A patient registered in your example is a female. I have to believe there are other possibly "male" gender related diagnosis codes also being added to the claim pertaining to the male gender. Adding the necessary KX modifier to those scenarios...
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    Wiki 88360

    You are very welcome, Stacey ~ I am super pleased that I was able to assist. If you ever need anything, please feel free to reach out. Have a fantastic evening! Dana
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    Wiki 88360

    Hello sdaniels, Again, I will try to assist you. From the final interpretation without seeing the gross or microscopic I cannot clearly tell the difference between 88305 or 88307. I'd like to pretend it is a punch skin biopsy, but I really do not know reviewing the information provided. The...
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    Wiki 88360

    Hello and Good Evening sdaniels; You brought up a very great immunohistochemical coding point today. May I break it down in the terms that I code? There are two primary immunohistochemical stains (those that are qualitative and those that are quantitative) "clearly" among others here. The...
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    Wiki Medicare Denial of 88305

    I am the kindest pathology coder you will ever meet. Did you even review your post? Take a moment, breath and re-read your post please okay now.
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    Wiki 88321 Special Stains

    Hello jperkins May I please respond? It may be lengthy, but I feel I may have the information you need for your question. Okay, the way that I have been taught is that if the pathology department (pathologist's) receives a specimen since I became a pathology coder in 2012 "it is clearly at...
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    Wiki FREE 2 CEU'S ~ Taking the Mystery Out of the Neoplasm Table Version 2

    Hello Everyone, Super Excited to share that the City of Palms AAPC Chapter is allowing me to present to their chapter again. Oh, My Goodness I am so giddy, they are so extremely kind with their hospitality allowing me to share this presentation that they are hosting. I presented Version 1...
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    Wiki Dystrophic Nail

    Yes
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    Wiki 88360

    Hello aamipatel, Yes, you may. I apologize for my delay. I believe I have information that may assist you for proper CPT coding assignment. Again, yes, 88360 may be clearly used for other areas of the body. I see it in other areas including brain specimens. Oh goodness, maybe it is time I...
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