Wiki Surgical pathology units

[cbtucaz]

New to pathology billing. Please help!
Is there a limit to the number of units you can bill Medicare for an 88305? Also, if there are several different diagnoses, do they get billed together (they are all 88305) or as a separate line item per diagnosis?
Thanks for any input!

 

[whaleheadking]

The unit of service in surgical pathology billing is the specimen. Multiple specimens can be submitted as a result of a surgical encounter that are accurately described by 88305. Specific LCDs may vary, but there is no reason to place a medically necessary limit on the number of Level IV specimens that a laboratory might receive. That is determined by the clinician.

Different practices assign diagnosis codes to specimens according to their own internal standards. Some laboratories assign diagnosis codes by the case, i.e. all the specimens will carry the primary diagnosis determined by the pathologist or the clinical indication if the diagnosis is negative for significant pathology. More conscientious coders will assign each specimen the diagnosis rendered on each individual specimen and bill these on separate lines. I have never found a standard protocol for this but the conscientious method adheres more closely to the standards established in ICD and really is more correct. Like many things in surg path billing, this is a gray area that probably merits further discussion.

Whichever method you use, there should be no reason to limit the number of Level IV specimens being billed. If a claim is denied, it should be appealed with supporting documentation that each specimen was individually examined grossly and microscopically, and diagnosed to further the patient's treatment plan.

Cheers,
WK
http://pathcoder.blogspot.com
www.whaleheadking.com