Hi vcooper,
You are correct - it is not the number of slides or blocks that determines the specimen, however your examples are a little vague (I'm unsure how the specimen/or specimens were provided to the pathology department for the pathologist's interpretation). I will try to explain the differences so that you may have the opportunity to compare the coding scenarios that you may be faced with for guidance.
We are to focus on identifying the specimen or specimens.
Example 1:
Two separate skin lesions are submitted in a single container. One is separately identified by a blue suture. Requisition states the biopsy without a suture is from the forehead and the skin biopsy with blue suture is from the nose. The work related to each of these biopsies are separately identified, each specimen is coded with 88305 with two units of service. Subsequent charge 88305 will require a modifier to be billed.
Example 2:
Two separate skin lesions, one 1.5 cm is acquired from the abdomen and the other 1.5 cm is also acquired from the neck and are both submitted in a single container for pathologist review. However, they are not separately identifiable (size is the same and no other identifiable difference between the two lesions). This will be coded as one specimen 88305.
Reviewing your scenarios -
Bladder - multiple blocks from multiple sites - was this a TURBT (88307) or biopsy (88305)? Is the specimen or specimen(s) separately identifiable from one another to report separately? Or possibly provided to the pathology department in separate containers for individual review?
Breast - 3 o'clock and 7 o'clock sites - were they in the same container (but separately identifiable in some type of form?). Such as the accompanying paperwork stated that 3 o'clock has margins inked in blue, green, orange, and black and the 7 o'clock has margins inked in red, yellow, purple, and green. The accompanying paperwork may state something to the fact that the larger specimen is from the 3 o'clock position. Does the microscopic state that margins were reviewed? If so then assign 88307 for each and if margins not reviewed then assign 88305 for each.
I hope this provides some insight with billing multiple specimens. Also when requesting help, a little snip-it of the pathology report can help with identifying what we are dealing with when billing charges or even coding to try to assist in helping.
Thank you for listening and have a great evening,
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT