Wiki 88305 Denials for Dx

[tori.a]

Hi,

Is there an NCD for 88305? I'm trying to find a credible list of payable dx codes but I'm not finding much. We are seeing denials when 88305 is billed with certain dx codes, R31.0 for example. Is this because it needs a neoplasm or some sort of growth dx?

 

[TThivierge]

Hi Toria
CPT 88305 is usually biopsy of some type of flesh growth from some organ. or skin location. The payers wants exact area on the body. Review the operative report or lab results should list if bx taken colon,(dx D12 block) growth off axilla D23 or scalp D23.4. Some lipomas are dx D17 nlock . Dx R31 is bloody urine which probably a differ lab test.
I hope helped you
Lady T

 

[brucep]

Horizon Blue Cross Blue Shield of New Jersey offers a useful, though not exhaustive, list of diagnoses in its policy document, Daily Maximum Units for Surgical Pathology and Microscopic Examination.