Recently, we sent information which reflects the CPT coding changes, additions and deletions for
2010. The purpose of this document is to provide further clarification on Medicare’s decision to
eliminate payment on physician consultation services and a focused review of two NCCI edit changes Per CMS’ latest version of the National Correct Coding Initiative (NCCI), the following first two items have been modified
1.) The unit of service for “special” stains (88312-88313) and immunohistochemistry (88342,
88360 and 88361) will be per block. When it is medically necessary and reasonable to
perform the same stain on more than one specimen or more than one block of tissue from the
same specimen, additional units of service may be coded and billed.
To clarify; a single block will include all multiple levels cut from the same block of tissue
stained with the same stain. The report documentation will need to support each block.
Acceptable documentation would be the name of each stain used per block/per specimen and
their results. In addition, if an IHC stain is performed, document whether quantitative or
semi-quantitative and the method, manual vs. computer-assisted is used. This coding policy
will apply to all insurances in addition to Medicare and Medicaid.
2.) The unit of service for CPT code 88172 (cytopathology evaluation of fine needle aspirate;
immediate study to determine adequacy of specimen[s]) will be per each separately identified
lesion or specimen. All “passes” from a single, separately identified lesion will be included
in a single unit of service of CPT 88172.
This coding and billing policy will apply to only Medicare beneficiaries. When coding for
this service, continue to report all “passes” as insurance information will not be known. APS
will review each case attempting to bill with more than one 88172 charge and code
appropriately for the insurance listed for the case.
3.) Effective January 1, 2010, Medicare has confirmed that it will discontinue paying the
outpatient and inpatient consultation CPT codes (99241 – 99255). Medicare has provided new
guidelines for reporting these services. These new guidelines will be followed for Medicare
As with Item #2, APS is implementing a pre-billing edit for Medicare claims that will allow
for the substitution of the correct CPT code prior to filing to the carrier. Therefore, it is
important to continue coding as previous.
Should you have questions or need further clarification, please feel free to contact Tom
Scheanwald at 800-288-8325, ext. 1417 or Jan Toczynski at ext. 1561. Thank you.