Part B Insider (Multispecialty) Coding Alert

Published on Fri Aug 23, 2013 PDF

Question: One of our providers will often dictate that he “obtained a culture for biopsy” and sent it for study. I have looked everywhere and cannot find a definitive code for the collection—I only find codes for the culture study itself. Is there a procedure code for the collections of specimens that we can use?

Codify Subscriber

Answer: In most cases, you cannot separately charge for collecting a specimen to send to the lab for culture, such as a purulent fluid or bone swab at the time of a biopsy. Medicare and other payers assume that the cost of obtaining the culture is included in the main code for the surgery the doctor performed at the time of the culture extraction, or in the biopsy code itself. The rules, however, are based on what type of surgery your physician was performing at the time of the specimen collection.

For instance, if the doctor was performing a biopsy of a skin lesion, you’d typically bill for either the excision or the biopsy, but not both. The following three guidelines can help you select which one you’d report:

1. If the surgeon performs incisional biopsy on a lesion or lesions, but does not remove any lesions completely, claim only the biopsy(s).

2. If the surgeon performs incisional biopsy on a lesion or lesions and follows by excising the remainder of the lesion(s) immediately (as in the case you cite), report only the excision.

3. If the surgeon biopsies a lesion but completely excises a different lesion, you may report both the biopsy and lesion codes, as appropriate, as long as the descriptor for the excision does not included the phrase “with or without biopsy.”