Bill by Specimen, Not Slide, in Surgical Pathology Claims
Question: Is it ever possible to bill 1 unit of 88302-88309 per slide, or must we always bill 1 unit per specimen? Revenue Cycle Insider Subscriber Answer: You must always bill units of 88302 (Level II - Surgical pathology, gross and microscopic examination…) through 88309 (Level VI - Surgical pathology, gross and microscopic examination…) per accessioned specimen, not per slide. This is what CPT® means when it states “The unit of service for codes 88300 through 88309 is the specimen” in the introduction to the Surgical Pathology section of the CPT® code book. The important thing to remember here is that the specimens must each be submitted in their own container. For example, suppose a provider submits three specimens. If each specimen the provider submits arrives in its own separate, labeled container, and supposing each specimen has its own separate requisition naming its source, then each one will receive its own microscopic exam, and each exam, three in total, gets its own line on the claim you submit to insurance. But if the provider submits three specimens in the same container, you will only be able to count 1 unit of the appropriate surgical pathology exam, even if the lab prepares two or more different slides from that container. Remember: Billing a high number of units isn’t always a matter of concern for payers. Prostate biopsies, for example, routinely consist of a large number of specimens. Each one will require its own separate exam, and you can bill each exam with a separate unit on the claim providing the units match the number of documented, accessioned specimens the provider has submitted. However, if the number of units billed is greater than the number of documented specimens submitted, the claim will be open to scrutiny and denial. Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC
