The nervous system enable the body to react to continuous changes in its internal and external environments. The decision making areas are the brain and the Spinal cord-termed CNS and the nerves that eminates from them containing fibers that import and export the necessary signals, are termed PNS. Embryologically, they all routed through what is called NEURAL TUBE. As it matures, the head end dilates in size and the end result is a swollen Brain at the top and the spinal cord at its tail!
For descriptive purposes, the nervous system is devided 1) structurally into the CNS and PNS.2) Functionally into the Somatic (SNS) and Autonomic Nervous System(ANS)
Spinal Cord and spinal nerves: The Spinal Cord gives rise to 31 pairs of spinal Nerves which along with the 12pairs of Cranial Nerves constitute the PERIPHERAL NERVOUS SYSTEM. The spinal nerves are distributed bilaterally , innervate the skin and skeletal muscles and could also convey axons of the autonomic Nervous System(which innervate the smooth muscles ,glands and the heart etc).A nerve can be somatic or visceral. And the fibers they carry give them a name as Somatic afferent and somatic efferent , or Visceral afferent and visceral efferent. Leave the controversies behind us.
Let us not fight for it in the coding area. Though they have similarities and differences they can not be limited on all these basis. The bottom line is, as I said, it all meant for a single purpose-to enable the body to react to the internal and external environments. Let us limit ourselves here.
Let me come to the point: The topic for discussion, is about the unit of Service for the codes, relating to the specimen report( Surgical Pathology). It is not the procedural service we deal with at present here-but for pathologic examination and diagnosis, and to assess the LEVEL to assign a code
So, these codes are from the levels we arrived at, upon the report of the pathologist. The real stumbling block starts from the Level 3 onwards.
As per the guidelines, 88304 through 88309-specimens requiring gross and microscopic exam, and represent additional ascending levels of Physician work. If we are to pick up from these designated list in the code manual, it is simple and plain. This is not the real situation we face. It does not represent the real scene of the Path findings and the amount of complexity and the work put forth with. Here lies the snag for the coders:
1)We cannot label the level with only dependence on the name of the specimen listed and the anatomical site, it is important, though, for analysis.
2) We have to take into account the Cyto Pathologist's amount of increasing work and the complexity of the Examination and the Pathogenicity of the disease.
The step by Step Text book clearly elaborates on to the leveling descriptions. But we stumble yet in assigning, though. We would have to take into consideration the ICD-9/10 diagnostic codes that are appended for. When we correlate all these factors, we are able to arrive at the appropriate level and hence the code to some extent. You are not satisfied. Is in it? Yes, nor do I!! because, it seems vague yet.
As for my openion, the names of the specimen listed in pages 374-376 in the CPT Manual, sometimes,though not many a time, do not correspond to the real surgical Pathology level the guideline suggested, while comparing the complexity of the examination report and the levels of work put forth by the Physician-meaning the real level deviates from the designated list of specimens and its level in the code book. The nerve tumor / biopsy may be one among them.
It is a real complex task for coders to assign, if we have those factors into account.
Could any one of you experts, make it easier to understand and assign the correct code relating to specimen report, in general. Your timely help would be greatly appreciated.
Thank you,