Mast Cell Disorders Forum - Billing: Lab code 88342 not covered?

Ladybug Ex Member	Billing: Lab code 88342 not covered? 03/29/14 at 13:24:44 Hello all, Today, I received my Explanation of Benefits from Tricare insurance for the recent endoscopy/colonoscopy. Tricare will not cover the Path Logic lab charge of $1,372.00 using code 88342. It's the weekend and thought I would check around to see if anyone has any experience with this? Thank you for any input!
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Joan

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Posts: 1502
Colorado

Re: Billing: Lab code 88342 not covered?
Reply #1 - 03/30/14 at 09:34:07

I don't know for sure, but I think there should be additional codes that define further what was tested.

If it were my bill, I'd call the lab and talk with the billing/insurance person to see if they will re-bill with the correct or additional code and also call the insurance company and ask what they need in order to pay the claim.

Good luck!

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Joan

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Ladybug

Ex Member

Re: Billing: Lab code 88342 not covered?
Reply #2 - 03/30/14 at 09:44:09

Joan wrote on 03/30/14 at 09:34:07:

I don't know for sure, but I think there should be additional codes that define further what was tested.

If it were my bill, I'd call the lab and talk with the billing/insurance person to see if they will re-bill with the correct or additional code and also call the insurance company and ask what they need in order to pay the claim.

Good luck!

Thank you, Joan. I am going to call them tomorrow. I've been trying not to think about it too much over this all weekend as I start to get a sick feeling in the pit of my stomach (we aren't rolling in the dough).

I was able to find a ruling for 2014 that would affect some of us masties regarding Immunohistochemistry 88343 (PC & TC) - "CMS rejected CAP's proposal and instead they will require the use of 2 new G codes for this service; G04061 to report one unit of service per specimen and G0462 to report each additional stain." Then they displayed a chart. I don't know what all this means, but I hope to find out more tomorrow.

Thank you again for responding!

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Ladybug

Ex Member

Re: Billing: Lab code 88342 not covered?
Reply #3 - 04/07/14 at 09:16:01

Hi Joan,

The lab cannot redirect the code. That is the only code for that staining with the diagnosis Mast Cell Activation Syndrome. Angry

As I typed this, a thought came to mind, I already know that I have MCAS. We were testing for forms of Mastocytosis. I wonder if changing the diagnosis would make the difference? I will call my insurance company tonight and ask them.

Meanwhile, I also had skin biopsies done several weeks back. The doctor said that he was going to tell the lab what stain to use. However, I never received a ridiculous bill from the lab for the special staining. This makes me wonder if they lab even checked. Also, the doctor gave me a copy of the results and there was no notation about the my mast cell per high power count. I just left their office a message.

Do labs automatically notate if mast cells are abnormal such as atypical mast cell type 1 or are spindle shaped?

Even my GI report does not show this, which makes me wonder if there was an oversight. Huh

I'm continuing to press forward with getting answers and making sure the doctors and labs test correctly.

Have a great day!

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Joan FORUM ADVISOR Offline Posts: 1502 Colorado	Re: Billing: Lab code 88342 not covered? Reply #4 - 04/18/14 at 21:00:21 If the doctor asked the lab to check numbers and shapes of mast cells, then they should have checked, but those things would have had to be requested.
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Ladybug

Ex Member

Re: Billing: Lab code 88342 not covered?
Reply #5 - 04/19/14 at 11:10:48

Joan wrote on 03/30/14 at 09:34:07:

I don't know for sure, but I think there should be additional codes that define further what was tested.

If it were my bill, I'd call the lab and talk with the billing/insurance person to see if they will re-bill with the correct or additional code and also call the insurance company and ask what they need in order to pay the claim.

Good luck!

Thanks, Joan. Tricare, the insurance company, said that they have to go by whatever the lab submits. They would not provide any code information to me. They said that it was not covered in my benefit package. They said that I could have the lab call them. The lab called them twice and was told that Tricare wouldn't accept the coverage also the lab said that that was the only code to be used for that specific test. It's so frustrating. Undecided

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Ladybug Ex Member	Re: Billing: Lab code 88342 not covered? Reply #6 - 05/25/14 at 18:13:56 Just an update that Tricare confirmed receiving my 25-page appeal packet, but that there aren't any updates. They told me to call back in a week. I'm counting the days!
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