Wiki Surgical pathology-Coding

KokilaG

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Hi,

We have coded CPT 88305 for Skin biopsy, but client is asking us to upcode the CPT to 88307 as number of cassettes is above 3. Can anyone confirm whether we can consider surgical pathology CPT 88307 based on number of cassettes?

According to me, we should not code based on number of cassettes, but we have to code based on specimen and the procedure done.

Please find the details given below and let me know the correct CPT for this.

SPECIMEN DESCRIPTION:
CLINICAL DATA R/O BCC
GROSS DESCRIPTION: Received in formalin is an oriented wedge of tan tissue measuring 23 x 9 x 3 mm in greatest dimensions. The specimen is serially sectioned in "breadloaf" fashion and entirely submitted in 6 cassettes.
MICROSCOPIC DESCRIPTION: There is a proliferation of fibroblasts aligned parallel to the skin surface interposed among linearly arranged, thickened collagen bundles and small blood vessels. (10I-MJ)
FINAL DIAGNOSIS
Left Central Chest, Excision: SCAR FROM A PREVIOUS PROCEDURE
Note: There is no evidence of the previously biopsied neoplasm in this multiply sectioned specimen.

Thanks in advance
 
You are correct - per Paget's, if it's a skin biopsy, it has to be a 305 no matter the size or number of cassettes (I have included the Paget's rule below). I hope this helps!!

Popular urban legend has it that it’s okay to report large or complex skin specimens—wide
excisions, melanomas, and basal cell or Merkel cell with margins immediately come to mind—at
the 88307 or 88309 charge level. Although these specimens unquestionably involve more work
than lesser samples, what can’t be disputed is that they’re still very much accurately described by
the label Skin, other than cyst/tag/debridement/plastic repair, which is the descriptor associated
with code 88305. Myth is myth, and slipping a few claims past Medicare and other insurers nowand-
again doesn’t make myth a reality; knowingly assigning an inaccurate code to a service for
the sole purpose of garnering more money is fraud!

The highest code level appropriately assigned to a “skin” specimen—as that term is generally
conceived and understood—is 88305. That’s true whether the specimen is a seborrheic keratosis,
a simple wart, a nevus, a wide excision or re-excision, a melanoma, or a basal cell or Merkel cell
carcinoma with margins. {CAP Today, Oct. 2005 and Mar. 2007} Here’s another way to look at
this: If the pathologic diagnosis properly translates to an ICD code in the series under C43, C44,
C4A, D03, D04, D22, D23, L25, L72, L85 or L90, then the highest code you can legitimately
report for the specimen is 88305. (The diagnosis codes cited here are for illustrative purposes
only: we’re not trying to present the universe of “skin” diagnosis codes.)
 
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