Surgical pathology CPT Coding

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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?
 
Hi KokilaG,
No, based on having a quantity of 3+ cassettes does not allow you to simply bill 88307. It is typical at our facility to see a melanoma excision "color-coded" on each side (such as - red, blue, yellow, green) to represent the orientation (which would be a minimum of 4 cassettes which already exceeds your 3 cassettes and to actually determine if the patient still has this medical condition or not (they will make all "several" cassettes necessary to either rule "this condition in" or goodness, hopefully "rule this condition out").
What do you have for a specimen? Basic non HIPAA information may provide additional answers to your question.
From my experience (coder, denials, coding analyst), I like to read both the macroscopic and microscopic of any pathology report to provide answers.
Some questions to keep in mind: Why was the specimen provided to the pathology department for review? What was the pathologist's final interpretation? Did you review the operative/procedure report - was the biopsy a "deep resection" - if so how far down (please review the microscopic)? Or by chance was this actually a soft tissue mass instead?
In my opinion - I would actually post these questions on the pathology forum instead of here. There are several really great coders that monitor that site often and provide help.
Have a Great Evening & Thanks for listening,
Dana Chock, RHIT, CPC, CANPC, CHONC, CPMA, CPB
Coding Associate Analyst (May 2018-Present)
Coder - Anesthesia (2013-2018), Pathology (2012-2018) and Laboratory (2012-2018)
 
Hi Dana,

I agree with your answer, we cannot code on the base of number of cassettes. We should see the specimen and procedure performed and can assign the code.

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
 
Hi KokilaG:
Based on what I am provided 88305 is the code that I would apply for this pathology. With the MM to CM conversion we are dealing with 2.3 CM x .9 CM x .3 CM. There is not mention of a deep resection and there is no mention of a soft tissue mass.
Have a great evening,
Dana
 
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