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BCBS of MI to Correct Processing of 88342

Beginning January 1, 2014, APS has seen systematic denials for multiple units of service of 88342.  This has been mainly due to addition of CPT 88343 and BCBS’ stance that it is inappropriate to bill additional units of service for CPT 88342.  APS recognized this as erroneous, given CPT’s description for this code set:

• 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 for primary procedure)

APS has been working on this issue with a member of BCBS of MI’s Provider Consulting Services team and we are glad to report some progress has been made.  Our contact has been working with the Medical Affairs department at BCBS of MI who reported the following:

“The quantity limit assigned to procedure code 88342 was re-evaluated by our Associate Medical Director who reviewed the information regarding the correct reporting of the code, including guidelines from essential coding authorities.  It was determined that under certain circumstances, it is appropriate to bill 88342 multiple times.”

The Provider Consulting Services team member went on to tell APS’ Director of Operations, Connie Orgel, that:

“Two requests have been initiated to update the BCBSM processing systems and ClaimsXten processing logic.”

This is great news for pathologists across the state of Michigan.  CMS cuts to the Professional Fee Schedule (PFS) have already driven down reimbursement metrics for 2014.  Continued commercial payor issues with the processing of IHC stains have amplified the blow.  This can be viewed as one of many necessary wins needed by pathologists.  APS is working to systematically submit corrected claims for our clients, where BCBS of MI has erroneously denied units of service for CPT 88342.  We will continue to work to ensure all clients are paid in full for services provided.  If you have any additional questions, please contact your Account Manager.

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