Pathology/Lab Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: We sometimes receive multiple needle-core breast biopsies from the same patient on the same day. In a recent example, the pathologist evaluated four biopsies from the left breast, each individually identified as to "quadrant" location within the lesion. I thought we should bill this as four separate biopsies, but I was told that we can only bill for one because the biopsies were taken through the same incision. Which is correct? South Dakota Subscriber Answer: Although it is true that you can only bill for one surgical procedure (such as 19102, Biopsy of breast; percutaneous, needle core, using imaging guidance) if the biopsies are taken through the same incision, it is not true that the pathologist can only bill for one biopsy examination. This discrepancy is often confusing, but the fact is that the surgical procedure and the surgical pathology specimen are not always one and the same.

The unit of service for surgical pathology is the specimen, which is defined by the CPT manual as "tissue or tissues submitted for individual and separate attention, requiring individual examination and pathologic diagnosis." In your case, the four biopsies are separately identified and, as such, require distinct evaluation and diagnosis. The pathology report should individually list each specimen and the pathologist's findings. Because these breast biopsies clearly do not represent the removal of the entire lesion, report each using 88305 (Level IV Surgical pathology, gross and microscopic examination, breast, biopsy, not requiring microscopic evaluation of surgical margins). Depending on the carrier's or other payers' rules, you should report the service by listing the code four times and appending modifier -59 (Distinct procedural service) to each code following the first, or list the code one time with the number "4" in the units box, e.g., on CMS form 1500.