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88304 vs 88305 when specimen has more than one diagnosis

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SBilb89

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17
Location
Glen Carbon, IL
On occasion I have a scenario where the physician assigns two codes for one specimen, for example L30.8 and L72.0. Now L30.8 would be an 88305, and L72.0 would be an 88304, how would I decide which one to bill? I can't find much information on this topic through google so I'm stumped.
 
At our practice we usually go by what the first listed diagnosis is for the specimen. So if dermatitis is listed prior to the cyst, we would code L30.8 & 88305. If the cyst is listed prior to the dermatitis, we would code L72.0 & 88304. I don’t believe there is a specific “rule” to follow in these scenarios….but that’s what we do!
 
nkovar said:
At our practice we usually go by what the first listed diagnosis is for the specimen. So if dermatitis is listed prior to the cyst, we would code L30.8 & 88305. If the cyst is listed prior to the dermatitis, we would code L72.0 & 88304. I don’t believe there is a specific “rule” to follow in these scena
SBilb89 said:
On occasion I have a scenario where the physician assigns two codes for one specimen, for example L30.8 and L72.0. Now L30.8 would be an 88305, and L72.0 would be an 88304, how would I decide which one to bill? I can't find much information on this topic through google so I'm stumped.
Click to expand...
At our practice, if the dermatitis is the initial finding then 88305. If the cyst is the main finding then 88304.
Click to expand...
 
Well, my question is what prompted L30.8 to be assigned? That isn't common. So, I am purely interested.
A cyst code usually would be an "incidental finding" but it entirely depends on the pathology report. If both dermatitis and a cyst were diagnosed during the same encounter (accession) I'll always assign the one that trumps the other diagnosis. You have proof that something (another medical condition) within the pathology report drives 88305 versus 88304. Be cognizant of how you prioritize the diagnosis codes. If you send the cyst as primary diagnosis it will be correcting invoice or appeal, it in my opinion.
Thanks for listening,
Dana
 
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