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Billing for FNA Adequacy


posts: 3 1 stars user offline United States

I'm looking for some references that will allow my lab to bill Technical Charges for cytotechnologist performed adequacy assessments on FNA's. AMA and CAP are in disagreement with ASC regarding the use of the 88172 code.

Due to the advise of AMA's "CPT Advisor" software, most labs and hospitals are not billing for this service although it may be perfectly legal and reasonable to do so.

Are any of your facilities currently billing, successfully for this service when it is provide by the cytotechnologist, under the general supervision of a pathologist, for an adequacy assessment (not a diagnosis)?

Thanks,

Steve Feher



admin posts: 330 5 stars user offline United States

Steve....I have to admit, it has been awhile since I was in a hospital based environment, but I will share my experience from both the academic and private community setting. I confess, that in my academic situation, cytotechnologists essentially functioned as first line triage, by performing a rapid assessment of sample adequacy PRIOR to calling for the staff pathologist to come view the sample and render any additional information to the clinician. So, in that scenario, the 88172 would be utilized, and on final interpretation the 88173. I envision this is the scenario that CAP/AMA are referring to.

In the community hospital setting, I would think it is the exception, rather than the rule, that there are hospital based cytotechnologists even available to perform a rapid assessment, as the pathologist, in my experience, is performing this solo, unless we are talking about a rather large community hospital. Of course in that scenario, as you describe, they would be available. Again, in my experience, the cytotechnologist is not providing the interpretation of the rapid assessment, but helping prep the sample and calling the pathologist when an adequate sample is available for evaluation as a rapid assessment. I am hopeful someone else can provide some useful feedback on this topic. You raise a very good question.


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