Pathology/Lab Coding Alert

Question: We sometimes perform a gross and a microscopic examination on two different specimens from the same patient on the same day. Should we use modifier -59 to show that we are not unbundling? Texas Subscriber Answer: Whether or not you use modifier -59 (Distinct procedural service) in this instance will depend on the payer. Medicare's CCI bundling edits do not disallow reporting a gross exam (88300, Level I Surgical pathology, gross examination only) with any of the other surgical pathology exams (88302-88309, Surgical pathology, gross and microscopic examination) for the same patient on the same day.

However, Medicare did at one time use proprietary edits that disallowed reporting 88300 with any other surgical pathology service. Some carriers and private insurers may still recommend using modifier -59 to indicate that the two codes represent services from different body sites or different patient encounters, for example. Reporting 88300 with a higher-level surgical pathology code for the same specimen would represent fraudulent unbundling. Reader Questions and You Be the Coder were answered and/or reviewed by R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark.; and Laurie Castillo, MA, CPC, CPC-H, CCS-P, member of the national advisory board of the American Academy of Professional Coders (AAPC) and president of Physician Coding and Compliance Consulting in Virginia.