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Pathology/Lab Coding Alert

You Be the Coder:

TC/26 Split Goes All the Way

Published on Tue Nov 08, 2011

Question: If our rural hospital lab receives a biopsy specimen and performs accessioning, gross dictation, and tissue processing to send the specimen to another lab for diagnosis, which code describes our service?Arkansas SubscriberAnswer: Based on your description, you probably don't have a chargeable service. Although the work fits the description of 88300 (Level I - Surgical pathology, gross examination only), you can't unbundle that service from the biopsy exam (88305, Level IV - Surgical pathology, gross and microscopic examination, Breast, biopsy, not requiring microscopic evaluation of surgical margins). Because you're sending the specimen to an outside lab for the 88305 service, your 88300 charge will come up against the 88305 charge with the same date of service and the claim will reject under the Correct Coding Initiative (CCI) edits. Exception: If your lab does the full technical service of preparing the specimen for the 88305 exam -- imbedding the tissue in [...]
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