Question Brain Biopsy

necruz

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Since the brain has different segments, when a pathologist has a brain biopsy and the specimens are submitted in separate containers, would you code for each specimen individually as 88307 x ??? (however many containers received), or would you code as a whole 88307 x 1 (no matter how many containers were received? Thank you.
 

TGRAY

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Per NCCI Manual Chapter 10: The unit of service for gross and microscopic surgical pathology (CPT codes 88300-88309), pathology consultation during surgery (CPT codes 88329, 88331, 88333), electron microscopy (CPT codes 88348) and morphometric analysis (CPT codes 88355-88358) is the specimen. A specimen is defined as tissue(s) that are submitted for individual and separate attention, examination, and diagnosis. Separate specimens are usually submitted in separate containers. It must be medically reasonable and necessary to submit the specimens for individual attention, examination, and diagnosis. For example, if colonoscopy identifies 2 separate polyps at 15 cm and 25 cm, it may be medically reasonable and necessary to submit them as separate specimens. If one of the polyps is malignant, it may be important to know for future therapy which one was malignant. Multiple biopsies of the same polyp are usually submitted as a single specimen.
 

danachock

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Hi, I have something to share on this scenario. Please do not assume that when a surgeon performs a brain biopsy that it "automatically warrants assigning procedure 88307”. Yes, you as the coder will ultimately provide both correct CPT and ICD code assignment based on each specimen received but please be cognizant of your CPT book.

Okay, there is no information provided on this scenario ~ so I will just hypothetically come up with a few scenarios for this discussion on familiar cases I have encountered when inaccuracies were encountered.

Let’s say the specimen’s final diagnosis is a benign neoplasm of the pituitary specimen that is assigned 88307 with dx D35.2. Your facility will probably be denied by a large majority of payors that the “diagnosis is inconsistent with the procedure”. Many of our insurance companies know that pituitary tumor is coded with 88305 from our CPT book.

Next example is a “biopsy of the brain” that ultimately turns out to be a blood clot received of the brain (so again I am unaware of the details of the actual findings) so I select I66.9 and then bill it with 88307 (but, per our CPT book the correct CPT assignment would be 88305 for “brain/meninges, other than for tumor resection”). Again, you would be denied payment for the same reason “diagnosis inconsistent with procedure”.

I am unsure if you work your own pathology denials, but this is what I see daily. I already know that when I see that denial reason – we are either going to probably correct the level of service or appeal the case with notes (pathology report). My philosophy has been to bill it correctly the first time, you eliminate the need for any corrections and simply appeal with the notes.

Thank you for listening & have a wonderful evening,

Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT
 
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