Question:

CPT® codes 88271 and 88275 have an MUE of 16 and 12 respectively. We use an outside reference lab that bills us a quantity of 1 and 1 cost for all tests performed. Should we (hospital) then bill a quantity of 1 and $1 total or bill quantity of 16 and 12 respectively with $1 amount?

Answer:

Since we do not know what was performed, we can only provide guidance for these codes.

Code 88271 is reported per unit for each probe analysis (ISH) performed. Each genetic syndrome/disorder is studied using different probe types, and each type of probe assists in identifying specific chromosome abnormalities. The number of units billed will be supported by the number of probes listed in the lab report.

For example, if the lab report states that BCR / ABL1 ISH is performed with dual-fusion DNA probes, then code 88271 x2 units will be billed. Code 88275 is reported as one unit per 100–300 cells analyzed by ISH. So, if the lab report shows 200 cells analyzed/counted for ISH study, then code 88275 is reported with 1 unit. The lab should include if the number of cells studied are per probe. If the ISH analysis is performed by a panel, it will be necessary to confirm with the performing lab the number of probes used for analysis.


CPT® is a registered trademark of the American Medical Association.

Facebook
Twitter
LinkedIn
Email
Print

CPT® copyright 2021 American Medical Association (AMA). All rights reserved.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.