Revenue Cycle Insider

Question: Our pathologist received and examined three separately identified skin lesion specimens from different body sites from the same patient on the same date of service (DOS). How do we code this to make sure the payer knows we are not submitting a duplicate bill for the same service?

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Answer: How you code multiple units of 88305 (Level IV - Surgical pathology, gross and microscopic examination … skin, other than cyst/ tag/debridement/plastic repair …) on the same DOS will very much depend on the payer, as there are several different ways to code this scenario, such as the following:

• List 88305 x 3 on a single claim line.
• List 88305 on one claim line, followed by 88305 with modifier 59 (Distinct procedural service) on subsequent claim lines for each additional lesion.
• List 88305 on one claim line, followed by 88305 with modifier XS (Separate structure, a service that is distinct because it was performed on a separate organ/structure) on subsequent claim lines for each additional lesion.
• List 88305 on one claim line, followed by 88305 with modifier 76 (Repeat Procedure or service by same physician or other qualified health care professional) on subsequent claim lines for each additional lesion.

How to choose: Although none of the preceding options are wrong, not all of them will get you paid by a specific insurer. Each Medicare Administrative Contractor (MAC) and each private insurer will have their own policies and preferred ways to handle situations like this. They will also have limits on the number of units you can bill per day.

Your best bet is to know what your payer prefers and code the situation that way. But make sure you have documentation that you’re billing truly separate procedures before filing your claim.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC