TC Billing for Slide Prep Only

[ejhahn]

Hello! We are currently billing slide prep only charges with a D48.5 (Neoplasm of uncertain behavior of skin). The pathologist is only preparing the slide for another pathologist to read, so there isn't a definitive diagnosis. I do not agree with D48.5, but am struggling to determine which code is the most applicable. I am going back and forth between D49.2 (Neoplasm of unspecified behavior of bone, soft tissue and skin) or L98.9 (Disorder of the skin and subcutaneous tissue, unspecified). The slide preps are all for skin specimens. Any coders have insight? Thank you!

 

[danachock]

May I provide my opinion ejhahn
When a specimen is provided to the pathology department there is a receipt (lab requisition) from another surgeon/clinician that tells you exactly what the specimen is being accessioned.
You need to review that if you are billing TC charges without a professional interpretation. No, you may not guess at D48.5, D49.2 or L98.9 diagnosis assignment please.
You have to have received a valid lab order (lab requisition) or whatever any other healthcare facility calls it. If they (clinicians/surgeons) state stuff like "rule out/squamous cell carcinoma of nose" that isn't valid. There has to be a "true" valid diagnostic reason on those forms. Don't be lazy. PLEASE EDUCATE YOUR ACCESSIONERS HERE! They should decline the receipt of something that I shared. If someone provides a "rule out" for indication for pathology review and pathologist states "consistent with"; what would you like me to provide for a final diagnosis?? This is real time information today.
What if no abnormality was found?? You need to fall back on exactly why the specimen was provided to the pathology department here. It isn't there.
I personally would have contacted my Medical Director in a heartbeat for an indication like this.
Educate the staff, know what can or cannot be accessioned. Do not provide diagnosis code(s) that are not documented.
You will fall back on the lab requisition here. Send it to the pathologist to provide their professional interpretation.
Have a fantastic evening,
Dana

 

[ejhahn]

@danachock
Thanks for your response. To clarify, if the requisition comes over with "BCC?" (for example) you are stating these should be sent back to the pathologist for clarification or not coded since there isn't a definitive diagnosis, is that correct? The pathologist is not the one performing the reading, only preparing the slide, so cannot necessarily give their professional interpretation. Typically the preop dx is on the report, which is what we code, but occasionally, there is a question mark by the diagnosis (i.e. BCC?, SCC?), which is where my question comes in.

While I do appreciate your response, I don't feel that calling me "lazy" was necessary. I am new to this role and trying to update our processes. This has always been such a helpful, no judgement, professional forum.

 

[danachock]

Hello ejhahn, If you review my comments. I wasn't stating you were personally lazy. Merely stating that this an exciting opportunity for educational opportunities and apologize if I came across otherwise here.
I love education and training. Pathology is my only passion and my forever career. I have been waist deep here since 2012.
What was the final interpretation here? The pathologist's isn't just preparing the slide(s). They (that pathologist) are providing their professional interpretation. That is their final diagnosis and RVU's.
In your coding opinion here; Is it codable based on ICD guidelines?
If I receive something (BCC?, SCC?) of this nature as the indication for visit? It is not useable. It is not definitive. That again, is why I am being kind explaining that if your accessioners don't know. Who knows here. No one doesn't "know" until they really "don't know". This is not a common thing any health facility would accept in the pathology specialty here.
If I had accessioned either possibility, I would have kicked it back to referring facility for an appropriate diagnosis. You don't get to offer a rule out diagnosis on the specimen indication. They (referring folks) have plenty of opportunities to discuss AK, lesion, elastosis, melanin issues, crust, inflammation, hyperplasia for the reason for visit but give questionable indications.
What if Dr. Pathologist's Dr. Cookie Monster stated that Patient was "Consistent with BCC of left arm" OR "consistent with SCC of left arm" You SERIOUSLY have nothing to fall back on here.
I am hopeful I provided insight on my alignment of thinking here. I don't accession cases. Can't code that. I purely help pathology specialty along with all my rationale. Please comment if you have more questions okay.
Evening,
Dana

 

[dcasey4263]

Hello! We are currently billing slide prep only charges with a D48.5 (Neoplasm of uncertain behavior of skin). The pathologist is only preparing the slide for another pathologist to read, so there isn't a definitive diagnosis. I do not agree with D48.5, but am struggling to determine which code is the most applicable. I am going back and forth between D49.2 (Neoplasm of unspecified behavior of bone, soft tissue and skin) or L98.9 (Disorder of the skin and subcutaneous tissue, unspecified). The slide preps are all for skin specimens. Any coders have insight? Thank you!

Would the pathologist reading the cases be able to provide you with the results in order to help you with the code? What cpt code are you using? Does the pathologist request special stains? Depending on the diagnosis you could bill 88304 or 88305.

 

[danachock]

Hello dcasey4263,
It just really "depends on" is my answer here all day long.
I have worked for facility that requires permission to change anything, and I have also worked for facility that requires to just code it as pathology report presents itself.
Did the pathologist really review the codes being billed. Sometimes the pathologist doesn't accession the specimens and someone else does here (dropping an 88304 for an accession when at review by pathologist it was deemed a neoplastic process and not a cyst or lipoma or skin tag truly deserving an 88305 designation)??
Your questions, I do not know. You would need to help me to actually help you here please.
Yes, the pathologist will do special stains and immunohistochemical stains. Are you acclimated with how each one is identified and billed.
You last statement on "depending on diagnosis you could bill 88304 or 88305". Yes, you are absolutely correct. I always error on side of caution here.
Adipose tissue within the final diagnosis and a pathologist gives me 88305 is an immediate change to 88304 assignment.
Receipt of tissue for skin tag or cyst and it was actually something else such as D22.x, C44.x, or D04.x as suggestions would warrant an 88305 here versus 88304.

 

[dcasey4263]

Hello dcasey4263,
It just really "depends on" is my answer here all day long.
I have worked for facility that requires permission to change anything, and I have also worked for facility that requires to just code it as pathology report presents itself.
Did the pathologist really review the codes being billed. Sometimes the pathologist doesn't accession the specimens and someone else does here (dropping an 88304 for an accession when at review by pathologist it was deemed a neoplastic process and not a cyst or lipoma or skin tag truly deserving an 88305 designation)??
Your questions, I do not know. You would need to help me to actually help you here please.
Yes, the pathologist will do special stains and immunohistochemical stains. Are you acclimated with how each one is identified and billed.
You last statement on "depending on diagnosis you could bill 88304 or 88305". Yes, you are absolutely correct. I always error on side of caution here.
Adipose tissue within the final diagnosis and a pathologist gives me 88305 is an immediate change to 88304 assignment.
Receipt of tissue for skin tag or cyst and it was actually something else such as D22.x, C44.x, or D04.x as suggestions would warrant an 88305 here versus 88304.

Hello danachock,
Thank you for your response. I was posing questions to ejhahn, thought it may help with their workflow.