Heme-path billing question...

[cmz]

Since medicare does not pay for duplicate testing, how do you all get around reporting which markers you use in your flow cytometry cases that are tied in for the same or similar specimens (e.g. bone marrow, lymph node, etc)? My take is that, for example, if you perform CD20 by flow, then you cannot bill for the CD20 IHC that you order on the patient's bone marrow.

I can easily navigate around this issue with my plasma cell neoplasms. For flow, I always state that plasma cells are often underestimated by flow cytometry. In my bone marrow reports, I have to state why I am using CD138 (again, since I apparently already used it with my concurrent flow case). The cases I dread writing up are my lymphoma work-ups where I employ a routine battery of CD markers to help me make a diagnosis. A lot of my stains are technically already 'eaten up' if I have concurrent flow cytometry.

How do you all handle reporting IHC and flow markers for these cases?

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[Autopsy101]

We do both IHC and flow, but only bill one or the other on duplicated markers depending on which study was the most informative. It makes our billing a pain in the a$$ because there are all kinds of charges to add and subtract from the LIS. Following to see what others are doing.

 

[LADoc00]

I do IHC on a different specimen like core sample B, than the flow.

That being said, does someone actually look at which ab you have done by flow and then not pay if you also repeated by IHC on the same specimen? No. Perhaps only in a RAC audit setting.