Audit Finds Florida Medicaid Is Erroneously Denying Claims

September 15, 2014

A recent billing audit we conducted for one of our clients led to a very serious finding that affects all pathology practices in Florida. We learned that several new 2014 CPT codes for immunohistochemistry stains (G0461, G0462 and 88343) are not listed on the 2014 Florida Medicaid fee schedule.

This is causing Florida Medicaid to erroneously deny claims when:

  • A combination stain is billed to Medicaid.
  • Florida Medicaid is secondary to Medicare or any other carrier that accepts G codes for IHC stains.
  • G codes for IHC stains are billed to Florida Medicaid instead of using 88342.

These codes should be available for use as described in the 2014 CPT and HCPCS books:

88342 – Immunohistochemistry or immunocytochemistry, each separately identifiable antibody per block, cytologic preparation, or hematologic smear; first separately identifiable antibody per slide

88343 – Each additional separately identifiable antibody per slide (list separately in addition to code from primary procedure)

G0461 – Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain

G0462 – Immunohistochemistry or immunocytochemistry, per specimen; each additional single or multiplex antibody stain (list separately in addition to code for primary procedure)

It is imperative that you audit claims for these codes and follow up on denials to ensure payment.

Vachette Pathology is an auditing and practice management firm working with practices in Florida and across the nation.  We are not a billing service — we make sure billing is done right.

For further information, contact Mick Raich at 866-407-0763 or mraich@vachettepathology.com.  To keep updated on this and other current issues, read our latest news at VachettePathology.com or follow Mick Raich on LinkedIn.

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