Roger: Flow Cytometry is one of the few areas where a repeated CPT code on a bill is not a problem as the code was set up for"each marker". The rule of thumb we use here is,1) can you clinically justify it as medically necessary (there is ample published literature to support the usefulness of the combinations you mentioned)2) did you perform the test 3) did you report the results. The only exception to this as I am advised by our consultants (E&Y) is when markers are used for quality assurance purposes only, such as isotype controls or CD45 for gating purposes only. In this case the lab is expected to eat the cost. More importantly here is that you have an appropriate diagnosis code (ICD9) to match your CPT code otherwise the whole thing will automatically be rejected. For a complete listing of acceptable diagnosis codes for flow cytometry check out www.empiremedicare.com, but keep in mind this is for NY (although most fiduciaries follow the suit of others). Good Luck! Joanne Thmas > From: rorlandi@inet.guthrie.org > Date: Fri, 15 Jan 1999 07:47:29 -0500 (EST) > To: Cytometry Mailing List <cytometry@flowcyt.cyto.purdue.edu> > Subject: Add to Cytometry Mailing List and Charge Code 88180 Question > > Dear Dr. Kelley, > > Allow me to introduce myself. My name is Roger Orlandi and I started in > Flow Cytometry in Feb. 1998. My background was 22 years in Hematology, > the las 17 as Supervisor. I moved into Flow Cytometry when an unexpected > opening occurred just prior to the Hospital Laboratory and the next door > Clinic Laboratory consolidated. > > Please subscribe me to your Cytometry Mailing List. Also, would you ask > your members the following billing question. The question is in a two > color panel of reagents using a marker more than one time with different > other markers, is it justifiable to charge for the marker a second time. > Example: in this 4 tube panel of CD3/CD19, CD5/CD19, CD10/CD19, and > CD5/CD23 would this be correctly billed as CPT-88180 (X5) or would it be > understandable and justifiable to bill CPT-88180 (X8). Being new to Flow > Cytometry and relatively a novice in billing practices, I think that the > significance of the co-expression of markers makes the (X8) > understandable, but whether it is correct (lawful) or not, neither my > Pathologist Director or other in-house billing people seem to have a > knowledgeble answer. We have been currently billing the lower number of > markers to be on the safe side. > > Any insite or information on acceptable billing practices in Flow > Cytometry would be greatly appreciated. > > Sincerely, > > RSO > > rorlandi@inet.guthrie.org > > >
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