You be the coder:
Avoid Tonsil/Adenoid Trap
Published on Mon Oct 12, 2009
Question: A common specimen for us is one container that includes bilateral palatine tonsils and fragments of adenoids. We can easily distinguish right and left tonsils from adenoids (but not from each other). Our report separately describes tonsillar tissue and adenoids in the gross and microscopic sections, and lists tonsils and adenoids as two, separate-line diagnoses. Can we bill 88304 x 2 for the one specimen container (one 88304 for the bilateral tonsils and one 88304 for the adenoids)? Pennsylvania Subscriber Answer: The example you give warrants one unit of 88304 (Level III -- Surgical pathology, gross and microscopic examination, tonsil and/or adenoids), not two. Here's why: The CPT descriptor bundles tonsils and adenoids as a single specimen. The "or" in the descriptor means that you should report 88304 if you examine tonsils or if you examine adenoids. The "and" in the descriptor means that you should report 88304 if you [...]
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