How many units of CPT 88321 can a provider bill?

10 Nov

Question to Healthcare Fraud Shield

How many units of CPT 88321 (Consultation and report on referred slides prepared elsewhere)[1] can a provider bill and how multiple units can be billed? I have some providers billing per specimen and some per date collected.

Dear Healthcare Fraud Shield Reader:
Great question.  According to the AAPC Coding Tool-AAPC Coder[2], a qualified provider, typically a pathologist, receives a consultation request and prepared slides from another location that he/she reviews as part of a consultation. A consultation request can come from another pathologist, surgeon, or other clinician. The consulting provider may review multiple slide types, such as cytology or tissue slides, from different body areas that count as one surgical pathology case. After a thorough examination of the slides, he prepares a report detailing his evaluation and opinion.
In other words,  the report can be on one (1) or multiple slide types, and from one or more body areas — but the bottom line the billing is “1”, as in one (1) surgical pathology case.  There should also be a detailed report of the findings.  So to answer your question, one (1) report/ DOS.  Unlike most other surgical pathology codes, the specimen is not the unit of service for 88321 to 88325. The surgical case is the unit of service.
**Be sure to check payer policies before reporting this code. Some payers may limit you to reporting 88321 once per patient per day even when the provider consults on more than one surgical case.

[1,2] coder.aapc.com

Questions or comments?  Please feel free to contact Healthcare Fraud Shield’s Subject Matter Experts at SIU@hcfraudshield.com for more information.

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