Explaining CPT 88323 usage and definition
Summary:
Learn about CPT Code 88323 is a Level III pathology HCPCS commonly used in conjunction with Modifer 26 TC for material requiring preparation of slides. Learn more about every detail regarding this code in this article with pictures to illustrate the power of an AI code scrubber to ensure optimal coding efficiency and compliance.
Formal and Layperson Definitions of CPT Code 01996
We’ve provided both the AMA description as well as the layperson’s definition of CPT Code 88323 below so you can use it for medical notes as well as to easily teach the code to your newer medical coders and billers.
AMA Definition of CPT Code 88323
Consultation and report on referred material requiring preparation of slides.
How to Explain CPT Code 88323 to a New Medical Coder
Surgical pathology consultation and report on referred material requiring preparation of slides.
Current CMS Status of CPT Code 88323
ACTIVE CODE: These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an "A" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy.
882323 CPT Code General Information
88323 cpt code has a diagnostic family of 99, with no age range, and has an MUE Count of “1”, and HOS MUE Count of “1", and this code should be billed in a Non-Facility Only setting (POS).
There are 31 Outpatient CCI Bundled Codes that could apply, so make sure you use iVECoder or VirtualAuthTech to properly select the right bundled code. Remember that unbundling codes leaves your payer organization and/or clinic up to fines and possible reimbursement decreases due to incorrect encounter data.
There are 31 different bundled codes that could be included within this code. A reminder that unbundling codes can lead to denials, or audits that leave your organization (whether clinic or payer) at a financial loss when you consider the cost of reworking, resubmitting claims, and potential financial losses due to unclean encounter data (unclean claims submitted and/or paid).
Places of Services
There are 49 current POS that could be use ranging from Pharmacy (01), Homeless Shelter (04), Assisted Living (13), Walk-In Retail Health Clinic (17), Urgent Care (20), Inpatient Hospital (21), and many others. To get the full listing enroll IVECoder for Clinics or VirtualAuthTech for Payers.
Modifiers and Places of Service for CPT Code 88323
There are currently 61 different possible modifiers that can be used in conjunction with CPT Code 88323, some of the most common being 26 for Professional Component, 33 for Preventative Services, 50 for Bilateral Procedures, 59 fo Distinct Procedural Services, AF for Specialty Physician, and AG for Primary Physician. For a full listing of all modifiers enroll in
VirtualAuthTech (payers) or
IVECoder(clinics).
Bundled Codes and NCCI Edits for 88323
With 61 CCI edit and 14 APC bundled codes, using an AI code scrubber could mean the difference between billing your claim or paying a claim one time the right way, or leading to potential auditing risks. It's not that you can't find this through a coding book, but there are simply too many codes and things to consider, so just let AI coding software with an AMA license give you the information and then you can choose what claim you process.
Contractual Rates for 88323
by using an iVECoder or Virtual AuthTech you can also set your GPCI and then dive deeper into the specific code (88323 cpt) and see what 100% to CMS payment is, then alter the "show cms payment @" section to calculate 120% or higher to help negotiate the best rates. Additionally it will show both the non-facility versus facility rates, further helping you with your DOFRs.
88323 CPT Code Final Thoughts
88323 is paid separately under the physician fee schedule used for Level III Pathology. With so many modifiers, POS, and additional considerations, it is highly recommended that payers and clinics both use either iVECoder or VirtualAuthTech to ensure they are coding or paying out claims correctly.
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