Part B Insider (Multispecialty) Coding Alert

Published on Fri Mar 08, 2013 PDF

Question: When our pathologist examines scar tissue, or tissue with a diagnosis related to scarring, can we bill 88305 if the specimen difficulty warrants the charge? Is there any time that a scar should not be 88305?

Answer: Yes, you can sometimes bill a scar specimen as 88305, but some guidelines might clarify when you should and shouldn’t do so.

You might report your surgical pathologist’s exam of scar or "scar related" tissue using any of the following codes, depending on the circumstances:

88302 — Level II - Surgical pathology, gross and microscopic examination… plastic repair…

88304 — Level III - Surgical pathology, gross and microscopic examination… skin - cyst/tag/debridement or Soft tissue, debridement…

88305 — Level IV - Surgical pathology, gross and microscopic examination… Skin, other than cyst/tag/debridement/plastic repair….

The code choice depends on the circumstances of the case, including the tissue origin of the scar (skin or soft tissue) and the extent of the service. Look at the following tips to help you decide when a scar fits under each code:

88302: Use this when the scar originates in the skin, and the pathologist’s work essentially involves tissue from "plastic repair." That means the scar is an incidental part of a plastic repair procedure, and the specimen shows no significant pathology.

88304: A scar that originates in soft tissue or skin could qualify for 88304 when the specimen is essentially equivalent to a debridement. A "simple scar" removed for pathologic diagnosis, not as an incidental part of plastic repair, would qualify for 88304.

88305: A more complex skin scar specimen, such as a keloid scar or a tumor excision/re-excision, qualifies for this surgical pathology level under the catch-all skin code "other than cyst/tag/debridement/plastic repair."