Advanced Search

Pathology/Lab Coding Alert

You Be the Coder :

Counting Won't Predict Proper Prostate Code

Published on Sat Jul 25, 2009

Question: Our pathologist received two containers from surgery, one identified as "right prostate" and one identified as "left prostate." Each vial contained four prostate needle core biopsies. Should we report this as 88305 x 8, or 88305 x 2? Louisiana Subscriber Answer: You would properly code this case as 88305 x 2 (Level IV -- Surgical pathology, gross and microscopic examination; prostate, needle biopsy). The reason you can't code 88305 x 8 is lack of documentation. You might expect 10 to 12 specimens for a conventional needle core biopsy, and you can appropriately bill 88305 for each separate needle core if you meet specific criteria. Those criteria are: the surgeon must separately identify each core (usually by location), and the pathologist must separately diagnose each piece of prostate tissue. Because your case involves only two separately identified specimens, you can bill only 88305 x 2. Caution: Medicare requires a different code [...]
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