danachock
Expert
Hi, I have a general question regarding pathology I would like to ask, and I was hopeful my AAPC pathology colleagues would have some insight to offer on my findings please.
As I become acclimated in my new pathology role, I have had the opportunity to come across a few coding scenarios and wanted to reach out if these policies are followed elsewhere, please.
Does anyone have any "internal" pathology policies while coding their pathology charges?
Let me provide a few of the examples I have recently reviewed -
When to bill for a regional resection (88307) versus a biopsy (88305)? Does the number of lymph nodes drive the CPT or is it the surgical approach that directs the assignment of CPT for this?
When to bill for a ureter biopsy (88305) versus resection (88307)? Does the length of ureter determine/drive the CPT assignment?
Billing for a uterus prolapse (88305) and if during the pathology microscopic, something else was discovered such as a uterine leiomyoma or even Endometrial Intraepithelial Neoplasia?
For an Endoscopic mucosal resection at what point does it update from procedure 88305 to an alternative CPT code based on tumor resection or low/high grade dysplasia?
Are there any internal policies on when to bill a bladder biopsy (88305) versus a TURBT (88307) that was performed?
CPT code assignment for Angiolipoma different from Lipoma?
Any advice you can provide would be appreciated. It doesn't even have to be relevant to the examples I just provided. This could be for any pathology topic.
Thank you in advance for any advice and have a wonderful evening!
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT
From my recent pathology reviews - I would like to leave my pathology colleagues with a few things I have identified and wanted to share.
Liver biopsy is 88307
Pancreas biopsy is 88307 (this is the one CHARGE that is mostly missed on my reviews). Please be super cognizant.
Nails submitted for review for a stain to rule out/in fungus is 88304 with stain(s)
Please make sure that you are applying a specified diagnosis code for the "term" on placenta (3rd term versus NOS) to capture possible denials. For example - when you assign O43.90 that gives the insurance company room to first deny for unspecified and not properly dating the specimen at hand (the trimester or weeks). Most pathology reports will provide "mature placenta" or the number of weeks, but this may be an area to focus on.
As I become acclimated in my new pathology role, I have had the opportunity to come across a few coding scenarios and wanted to reach out if these policies are followed elsewhere, please.
Does anyone have any "internal" pathology policies while coding their pathology charges?
Let me provide a few of the examples I have recently reviewed -
When to bill for a regional resection (88307) versus a biopsy (88305)? Does the number of lymph nodes drive the CPT or is it the surgical approach that directs the assignment of CPT for this?
When to bill for a ureter biopsy (88305) versus resection (88307)? Does the length of ureter determine/drive the CPT assignment?
Billing for a uterus prolapse (88305) and if during the pathology microscopic, something else was discovered such as a uterine leiomyoma or even Endometrial Intraepithelial Neoplasia?
For an Endoscopic mucosal resection at what point does it update from procedure 88305 to an alternative CPT code based on tumor resection or low/high grade dysplasia?
Are there any internal policies on when to bill a bladder biopsy (88305) versus a TURBT (88307) that was performed?
CPT code assignment for Angiolipoma different from Lipoma?
Any advice you can provide would be appreciated. It doesn't even have to be relevant to the examples I just provided. This could be for any pathology topic.
Thank you in advance for any advice and have a wonderful evening!
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT
From my recent pathology reviews - I would like to leave my pathology colleagues with a few things I have identified and wanted to share.
Liver biopsy is 88307
Pancreas biopsy is 88307 (this is the one CHARGE that is mostly missed on my reviews). Please be super cognizant.
Nails submitted for review for a stain to rule out/in fungus is 88304 with stain(s)
Please make sure that you are applying a specified diagnosis code for the "term" on placenta (3rd term versus NOS) to capture possible denials. For example - when you assign O43.90 that gives the insurance company room to first deny for unspecified and not properly dating the specimen at hand (the trimester or weeks). Most pathology reports will provide "mature placenta" or the number of weeks, but this may be an area to focus on.