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88305 or 88307

  1. Talking 88305 or 88307
    Medical Coding Books
    kidney soft tissue mass bx- dx is carcinoma
    ( do you code that as kidney bx =88305 or soft tissue mass bx = 88307)

  2. #2
    I would play it safe and code it 88305 kidney biopsy.

  3. #3
    Kidney. It may be soft but the anatomical definition of soft tissue is not organ tissue. A nephrectomy is probably on the way so 88307 then.

  4. Default
    Well, I am strongly for the code 88309.. You do have the Pathology report in your hand- Surgical pathlogy report- Carcinoma (may be kidney As given info)
    LEVEL VI-includes EXAMINATION OF NEOPLASTIC TISSUE- all the more for Ca.
    irrespective of your type of surgery pending. You can not wait till the surgeon fixes a type of surgery sooner or later or may not (may be patient's condition not warrant for a / the sugery or they opt for radio- or chemotherapy.

    Pathology report is pathlogy report interpreted and documented by Pathologist and the due money is to go for HIM/HER , not depending upon SURGEON'S Decision on further surgery
    Most of the Neoplasms, and all the malignancy specimens are for the highest pathology code -Level 6.
    Have you noticed there is no one list in any of the pervious codes 88300-88307 (and it is logical and justified too) that the malignancy codes are included.
    More over Level VI Pathlogy Code includes examination of neoplastic tissue or very involved specimens.88309 All the more give credits to the Pathologist for the increasing works he put forth ( physically, mentally, knowledge& wisdom-wise, intelligence-wise and the certified and the only responsible status as a "Pathology-reporting Physician" to work on a specimen of highest COMPLEXITY.
    So, I will code for only 88309
    Last edited by preserene; 08-01-2010 at 02:16 PM.

  5. #5
    A kidney biopsy is a listed CPT code (88305). You should not upcode a biopsy code based on the DX. Nor should you upcode based on a surgery that may or may not happen. In coding there is a lot of gray areas, but when it is in black in white. Then it is black and white.

    Just my 2cents.
    Last edited by tomtom2; 08-02-2010 at 08:24 AM.

  6. Default
    Well , when you get the whole mass of Cancer specimenor even the tissues, was it not a surgery to validate the procedure as Surgical PathologyService.
    Our survice under discussion, is Surgical Pathology Service
    Then, if we get to the text book of Step by Step by Carol J.Buck Page 395 classification of the Leveling says " LEVEL VI code 88309 includes examination of neoplastic tissue or very involved specimen". what do we infer out of it?
    A specimen is defined as tissue submitted for examination. And your specimen was a "mass of Tissues"
    It is the ascending level of the Physician ( Pathologist's) work, not the ascending level of Surgeon's work that determines the coding guide line in the CPT in this section.
    Would you give more wieght on the guide lines and the factors attched to it to place the LEVEL or just name in the list/or terminolgy in the list of the leveling. It is a cancer mass or tissues sent as specimen and not a biopsy specimen by the way (even if I tread on your line). Why do you consider it as biopsy specimen at the first place, when the whole lot of mass is sent to you for pathology Examination. So even if the whole lot of the whole kidney Cancer specimen sent for, you would code only 88305 saying it is kidney biopsy and is listed or labeled in the 88305. By the way the specimen was not named as Biopsy specimen-Kidney Biopsy,here it is immaterial, though.
    NO CANCER NEOPLASTIC SPECIMEN IS LABELED OR LISTED INTO ANY LEVEL LESSER THAN LEVEL VI. I think I make a good sense, based on the guidelines and the authenticated text and CPT.
    I am not overcoding and, what if I say, that you are undercoding the service.

    I feel with a good note and user-friendly way, that some one who is the authority and expert in these coding, would kindly address our doubt Please.Ok?!! Let us be cool!!

  7. #7
    I have never heard of Carol J.Buck but her publication is very misleading and should be revised if it says "NO CANCER NEOPLASTIC SPECIMEN IS LABELED OR LISTED INTO ANY LEVEL LESSER THAN LEVEL VI". Maybe someone should report her publication to the AMA, CAP or CMS.

    Just a thought, you know before someone acually takes her advise.
    Last edited by tomtom2; 08-03-2010 at 10:28 AM.

  8. Default
    Her quote I have already given in" "LEVEL VI code 88309 includes examination of neoplastic tissue or very involved specimen". - in the previous sentences. I said based on the cpt guide lines at the start of the subsection and the text books classification of labelling I gave the inference as, 'NO CANCER NEOPLASTIC SPECIMEN IS LABELED OR LISTED INTO ANY LEVEL LESSER THAN LEVEL VI"..(you can see the list from level 1 to Level 6-just as to infer) I have read her text book well and it is very very fantastic and reliable one and I dont find any deviation from the cpt manual and the pracitices we are based on. medical analysis and critical thinking and evaluation also all the more important in coding,while assigning the code.
    By the way she is one of the best authority and her text book is one of the best for Coding. Any Coder would know her by her name and profound breathtaking work and efforts in coding profession. Please do not jump into judgement like that.

    My point is : for this case of discussion, 1) it was not just a kidney biopsy sample for you to assume it 'Kidney biopsy' and search for it as such in the list and find it in 88507 and just code it . It was a mass of resection tissue that was sent. Clinical relevance, the gross examination and the microscopic examination report all adds up. Any school child if you give a list and a name of the sample, to search for within that list, she or he will do it in a minute!!
    For us there are certain guidelines to follow too.
    If you do not find the name of the specimen(of the thousands various body tissues) in the list of 6 levels where do you place them? The list can not contain all of them.You can take, in many places, examples only and there comes our clinical/medical knowledge, critical thinking and analysis value.
    Why go that far, it is not a kidney "biopsy" tissue and the reason why the surgeon took a mass of kidney tissue-from a vital organ, and sent for Sur Path examination ( Gross and Mic ), it self, will suggest that there is a great possibility of malignancy and all the more THE PATHOLOGY REPORT OF 'CARSINOMA' itself SUFFICE THE SURGICAL PATHOLOGY CLASSIFICATION LEVEL DETERMINING, BY THE COMPLEXITY OF THE PATH EXAMINATION, THE CODE BE ASSIGNED AS 88309
    Thank you. I don't change my assessment until some authority from AAPC level reason out that I am wrong.

  9. #9
    I haven't had this much fun in a forum in a while.

    1st. The post on this thread is "kidney soft tissue mass bx" Bx stands for biopsy.

    2nd. A kidney biopsy specimen can be coded in seconds. Is pretty straightforward if you know what your doing.

    3rd. AAPC is not an authority. You'll be waiting a while to change your assessment.
    Last edited by tomtom2; 08-03-2010 at 01:38 PM.

  10. #10
    It was a kidney bx. 88305.

    I've never heard of Carol Buck and I don't think I want to based on what's being quoted.

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