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Scissor snip biopsy or removal, multiple specimens, path is not skin tag.

Hello,
Our staff comes across this type of note daily, and would like some clarification on what is the proper way to bill this scenario?
Thank you in advance.

Note copied below:
Dx given in note as D49.2 and skin tags.

Scissor Snip biopsy
Left axilla x4, Right axilla x3, Groin IFEP. The area was prepped with an alcohol pad, then 1% Lidocaine with epinephrine was injected around the site(s), Scissors and pickups were used to excise the lesion at the skin surface, Monsel’s solution was applied to obtain hemostasis. The patient is instructed to notify the office if the wound site oozes, becomes painful or red. The biopsy specimen was sent to the laboratory for pathological evaluation. Left axilla x4, Right axilla x3, Groin x1

(Path came back as Groin and Left axilla as warts, and the right axilla skin tag.)

Medical Billing and Coding Forum

88342 for multiple specimens

We billed two units for two specimens as follows:

88305- XS x 2
88342- XS x 2

and was paid by Humana for everything except 1 unit for 88342.

Does anyone know what the error is? I’ve been on the internet and really can not find anything up to date. Modifier 76 was mentioned, but think I will have to appeal in writing. The only thing is our office does this quite often and dread appealing every single claim! :-(

Humana is ridiculous!!

Medical Billing and Coding Forum

Travel allowance for collection of specimens


CMS revises the payment of travel allowances when billed on a per mileage basis using Health Care Common Procedure Coding System (HCPCS) code P9603 and when billed on a flat-rate basis using HCPCS code P9604 for 2018.

The travel codes allow for payment either on a per mileage basis for code P9603 or on a flat rate per trip basis for P9604. Payment of the travel allowance is made only if a specimen collection fee is also payable. The travel allowance is intended to cover the estimated travel costs of collecting a specimen including the laboratory technician’s salary and travel expenses.

Under either method, when one trip is made for multiple specimen collections (for example, at a nursing home), the travel payment component is prorated based on the number of specimens collected on that trip, for both Medicare and non-Medicare patients, either at the time the claim is submitted by the laboratory or when the flat rate is set by the MAC.

The per mile travel allowance (P9603) is to be used in situations where the average trip to the patients’ homes is longer than 20 miles round trip, and is to be prorated in situations where specimens are drawn from non-Medicare patients in the same trip.

Please note:  Your MAC has the discretion to choose either a mileage basis or a flat rate, and how to set each type of allowance. Many MACs established local policy to pay based on a flat rate basis only. 

See Fee rates for P9603 and P9604


Coding Ahead

coding for contaminated specimens

I am looking for documentation stating whether or not you can bill for contaminated specimens.
For example, if urine culture results are resulted as contaminated.
My research for documentation found that the CPT code 87086 all components are not met as the definition is culture, bacterial; quantitative colony count, urine. This code should not be reported as in the instructions for instructions for use of the CPT code book it states that we cannot approximate services provided to code selection"

There is also the modifier 91 for repeat lab test, and CMS states that it is inappropriate to use this modifier for labs that have specimen issues. you would only get paid for running the test once. https://med.noridianmedicare.com/web…s/modifiers/91. on a side note, I am concerned that medical necessity of the test is lost if it is not repeated as the results were not then needed for treatment of the patient.

Thank you in advance!

Medical Billing and Coding Forum