Wiki Two specimens in same bottle 88305 x1 or 88305 x2

[ltl226]

Hello,

I received the below pathology question and wonder if I could get any assistance on answering this?

"They did two procedures, but they're on the same site. And they put it in as A and B on the req, but the specimens arrived together in one bottle. So I'm not sure, would we bill this as 88305 X 2 or 88305 X 1?"



Thank you,
Laura

 

[danachock]

Hi ltl226
Well, this is interesting for a couple of skin biopsies. I personally haven't seen this before. Both the shave and punch biopsy are very common. I also do not have the "gross" description on what was received (on whether any margins were inked or if stitches placed for orientation) so I will elaborate on what I know from what you provided in your post okay.
I would bill this out 88305x2 and I'll clearly explain why. The shave was just a piece of the epidermis with some of the dermis (in layman's terms for the pathologist it would be much thinner than a punch biopsy).
A punch biopsy is the full thickness that takes the epidermis, dermis along with some subcutaneous fat. I've had this done and this procedure sometimes requires stitches.
Ultimately the punch would be deeper (thicker) than the shave biopsy. I do not know the reasoning behind this (but it has to be rare), like I stated earlier, I haven't seen this so maybe the surgeon saw something on the procedure table after the shave biopsy and had to "in a sense - dig deeper"? Sometimes without proper orientation specimens need to be bundled but I do not believe that this would be the case reviewing the two different procedures performed with your question. Again, the shave biopsy would be thinner than the punch biopsy.
Thanks,
Dana