Wiki Surgical path codes

[aknight836]

I am looking for clarification on the correct way to bill CPT Surgical Pathology codes when there are multiple specimen. Charges being billed are 88305x2 and 88304x2. Both 88305s have the same diagnosis code and both 88304s have the same diagnosis code. Which of these is the correct way to split and bill the charges? If both are correct please let me know.

A. 88305x1, 88305x1 with modifier 59, 88304x2 with modifier 59

B. 88305x1, 88305x1 with modifier 59, 88304x1 with modifier 59, 88304x1 with modifier 59

 

[danachock]

Hi aknight836
I do apologize if I am missing something here, but neither coding scenario above appears correct from your above example.
Billing 88305 with 88304 on the same DOS does not have a bundling issue. It is the level of Gross and Microscopic being performed by the pathologist.
Let me provide two examples on how this should have been billed okay. One facility doesn't always bill out charges as another facility and I have seen this both ways.

Example A:
Patient has procedure and four specimens each in its separately identified container Labeled A, B, C, & D received for both Gross and Microscopic review by pathologist
Specimen A - Left Nasal Contents which will bill 88305
Specimen B - Right Nasal Contents which will bill 88305
Specimen C - Left Septum biopsy which will bill 88304
Specimen D - Right Septum biopsy which will bill 88304
Example A will bill this out
88305x1 for Specimen A
88305x1 with modifier 59 (or XS modifier) for Specimen B
88304x1 for Specimen C
88304x1 with modifier 59 (or XS modifier) Specimen D

Example B (same example used):
Patient has procedure and four specimens each in its separately identified container Labeled A, B, C, & D received for both Gross and Microscopic review by pathologist
Specimen A - Left Nasal Contents which will bill 88305
Specimen B - Right Nasal Contents which will bill 88305
Specimen C - Left Septum biopsy which will bill 88304
Specimen D - Right Septum biopsy which will bill 88304
Example B from a facility that "rolls up their charges onto one line" will bill this type of scenario out
88305x2
88304x2

Please reach out if I misinterpreted something or if you have additional questions.
Have a great evening,
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT