Explaining CPT 88365 usage and definition
What will in this article?
Learn about CPT Code 88365, a Level IV pathology HCPCS commonly used for in situ hybridization (e.g., FISH) per specimen, particularly for the initial single probe stain procedure. This code is critical in genetic sequencing localization and plays a key role in surgical pathology. In this article, we’ll dive deep into the details of this code, including its guidelines and coverage considerations. You’ll also discover how AI code scrubbers can ensure accuracy, streamline coding efficiency, and maintain compliance within your pathology practice.
Formal and Layperson Definitions of CPT Code 88365
We’ve provided both the AMA description as well as the layperson’s definition of CPT Code 88365 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 88365
In situ hybridization (e.g., FISH), per specimen; initial staining procedure using a single probe.
How to Explain CPT Code 88365 to a New Medical Coder
Genetic sequencing localization, initial procedure.
Current CMS Status of CPT Code 88365
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.
GUIDELINES:
(Do not report 88365 in conjunction with 88367, 88368 for the same probe)
88365 CPT Code General Information
88365 cpt code has a diagnostic family of 99, with no age range, and has an MUE Count of “4”, and HOS MUE Count of “4", and this code should be billed in a Non-Facility Only setting (POS).
There are 14 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.
88365 CPT Places of Service
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 for CPT Code 88365
There are currently 61 different possible modifiers that can be used in conjunction with CPT Code 88365, 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).
Contractual Rates for 88365
by using an iVECoder or Virtual AuthTech you can also set your GPCI and then dive deeper into the specific code (88365 cpt) and see what 100% to CMS payment is, then alter the "show cms payment @" section to calculate 125% 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.
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