Advanced Search

Pathology/Lab Coding Alert

Compliance:

88305: Is 4 the New Prostate Biopsy Maximum for Medicare?

Published on Tue Oct 09, 2012

Palmetto GBA policy sets the tone. "I'm concerned that payers may interpret the NCCI Policy Manual to be distinguishing CPT 88305 vs. G0416-G0419 on sample number alone," states William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore. That's what we published earlier this year in "Mark 5 Prostate Biopsies as the Magic Cutoff for 88305" (Pathology/Lab Coding Alert Volume 13, Number 5). Now it seems that the concern is becoming reality. That was Then -- 88305 x 10 In 2009, CMS implemented HCPCS Level II codes for pathology exam of specimens from a prostate saturation biopsy (55706 -- Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance), which often yields 20 or more specimens, as follows: G0416 -- Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling; 1-20 specimens G0417 -- ... 21-40 specimens G0418 -- ... 41-60 specimens G0419 -- ... greater than [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Pathology/Lab Coding Alert

View All