Wiki Surgical Pathology 88300-88309

[Michele1229]

Hello -

We have a derm provider asking us some questions about the surgical pathology cpt codes and we want to make sure we tell him the correct answer. He wants to know the following:

Question 1:
As the pathologist, he may receive multiple specimens of the same thing in the same bottle, i.e. skin tags, that are not identified as to which body part or area they were excised from. He will bill 88305 for 1 unit. Is this correct? It almost seems like 88304 would be more correct and then the number of units would be the number of specimens in the bottle.

Which is correct?

Question 2:
As the pathologist, he may receive multiple specimens in the same bottle but they may be different types of specimens that are identified by the type of specimen and body area retrieved from. How should this be billed???

Question 3:
Is there ever a scenario where multiple units of the surgical path codes can be billed when the specimens are in the same bottle, regardless of if the specimens are the same type of specimen or different??

Thanks!!

 

[mitchellde]

Hello -

We have a derm provider asking us some questions about the surgical pathology cpt codes and we want to make sure we tell him the correct answer. He wants to know the following:

Question 1:
As the pathologist, he may receive multiple specimens of the same thing in the same bottle, i.e. skin tags, that are not identified as to which body part or area they were excised from. He will bill 88305 for 1 unit. Is this correct? It almost seems like 88304 would be more correct and then the number of units would be the number of specimens in the bottle.

Which is correct?

Question 2:
As the pathologist, he may receive multiple specimens in the same bottle but they may be different types of specimens that are identified by the type of specimen and body area retrieved from. How should this be billed???

Question 3:
Is there ever a scenario where multiple units of the surgical path codes can be billed when the specimens are in the same bottle, regardless of if the specimens are the same type of specimen or different??

Thanks!!

#1 Skin tags are 88304 the number of skin tags does not change the code. if it is all submitted in one container as one specimen then it is one unit.
#2 multiple pieces in the same container is still one specimen and is coded with one code and one unit.
#3 if submitted as one specimen in one container then that is how the pathologist is to treat it. he may make multiple slides out of one container but it is still billed as one unit regardless of the number of slides.
I sometimes have path reports with 20 different specimens identified each one in a different container, this is 20 units. then again it is not unusual to have one specimen such as uterus with ovaries and tubes and kidney all in one container but multiple slides, this is one unit.

 

[Michele1229]

Hey Debra -

May I ask one additional question to your response for #2.....

Does the units change in this situation if they are separately identified specimens? I agree if there are multiple specimens in 1 container and if they are NOT separately identified then it is 1 unit. But.... what if they are separately identified.... can we then bill multiple units???? We were kind of thinking yes in this case.
Thoughts?

 

[mitchellde]

No not if it is submitted as a single item. it does not matter how many organ samples are in the cassette if it is one cassette then it represents one unit.

 

[bbooks]

Great discussion! I disagree with the last point, though (unless I misunderstood the point you were making).

Speaking just in the situation of dermatology specimens, if two pieces of tissue are in the same bottle and the surgeon has specifically identified one by a stitch/clamp or by some distinguishing feature, AND the pathologist renders a separate diagnosis for each, then they are separately chargeable.

There is an extensive discussion of this sort of situation in Pathology Services Coding Handbook https://www.apfconnect.org/files/News/CodingManualPromo_16A_FN2.pdf

An example beyond dermatology specimens would be Fallopian tubes for sterilization. If submitted as right and left in separate bottles, or if in the same bottle and there is some notation that distinguishes laterality (e.g. "stitch/clamp on the right") AND the pathologist renders a separate diagnosis for each, then either supports 88302 X 2.

Beyond dermatology specimens, there are different guidelines for either separately charging commingled specimens that come in a single container (e.g. cystoprostatectomy) and bundling into a single charge specimens that are received in separate containers (e.g. removal of uterus, tubes, ovaries).