American Urological Association - Laboratory Pathology

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Home Practice Resources Coding and Reimbursement Coding Resources and Information Laboratory Pathology

Laboratory Pathology


Q.   Do I need to use modifier QW when submitting urinalysis?

A.   Some MAC Carriers are requiring modifier QW to be appended to CPT code 81003. Effective January 2016 CPT code 81002 non-automated, without microscopy does not require modifier QW. View the list from CMS.gov


Q.   We have a lab in our office and would like to start collecting cytopathology test for FISH, what is the proper CPT code?

A.   CPT Codes 88120 and 88121 are used to report in situ hybridization (e.g., FISH) testing for bladder tumor markers utilizing validated assays, i.e., the UroVysion™ Bladder Cancer Kit, to assist with initial diagnosis of bladder carcinoma in patients with hematuria, and subsequent monitoring for tumor recurrence in patients previously diagnosed with bladder cancer.


Q.   Medicare is denying claims with multiple units of 88341 stating that only 1 unit can be billed and if you need to bill more you have to put each one on a separate line on the claim. Can you tell me if this is right?

A.   CPT Code 88341 is used in conjunction with code 88342. The code descriptor reads:

Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure)

Yes, you would want to bill out this new code on individual lines to report how many stain procedures were performed.


Q.   We have recently received a denial from Medicare. We billed an 88305 with 14 units. We have an in-house path lab, and our pathologist examined 14 prostate biopsy specimens. What are the specific guidelines for reporting CPT code 88305?

A.   As of 2015 for Medicare patients it is recommended you bill HCPCS Code G0416 to reflect all prostate biopsies regardless of the number of specimens. Private payers are requesting CPT Code 88305 Surgical pathology, gross and microscopic examination. Practices will need to check with the major insurance companies in their area. 

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