MrsSpiney
New
Patient has 88307 DCIS, 88305 x5 negative margins. Do I code the DCIS for the 88305? thx
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Wiki Newbie with breast biopsy question
- Thread starter MrsSpiney
- Start date
danachock
Expert
Hello and good evening MrsSpiney,
I do not care if the margins were on fire here. Seriously, what did the pathologist state within the pathology report that I do not have the privilege to see?
Did you carefully access the "gross for inking and blocks" and did you also "carefully access the microscopic section of the pathology report"?
Surgeon's need to provide clear definitive margins within their specialty (breast cancer, melanoma, sarcoma) and just because the "margin" was negative doesn't mean it warrants 88305.
Please take the time to review the documentation and review your CPT book (were margins evaluated?). Those margins "need to be documented" to support driving an 88307 charge in your DCIS scenario you shared per our CPT book. If you feel they are doing the work and not documenting it, it would be super helpful & so kind to just reach out to them in a query to validate. There is a difference between receiving RVU's for 88305 versus 88307.
Thank you for listening & have a fantastic evening,
Dana
MrsSpiney
New
My question was about the diag. I am sorry if my question was unclear. Is there a different forum for new students for pathology questions? thank you
danachock
Expert
Yes, MrsSpiney I did not mean to alarm you from my prior comment. I am betting that all charges warrant the 88307 because margins were reviewed here.
I thought we were reviewing CPT not ICD here and I wholeheartedly apologize.
No worries, we are reviewing ICD, let's go "to the basics" here. What was the "reason for visit?" why is the patient in the in the OR? May I provide a fictional scenario here?
If a lumpectomy (Specimen A) was performed and all the margins (Specimen B, C, D, and E) were negative. You drive the final diagnosis. Pathology report states cancer, in situ, or otherwise for one specimen (Specimen A) and there isn't that finding in other specimens and those margins were inked and reviewed right (thankfully!!)? And as a pathology coder we "SERIOUSLY" get a moment to celebrate that operation and hopeful for our patient. As a Pathology Coder if the documentation states that specimen (Specimens B, C, D, and E) margins were reviewed. You CODE the findings on the patient's OVERALL pathology interpretation.
If this needs further discussion, please reach out to me in the AAPC "inbox" please. I am OOO next week and my replies will be irregular, but I will help you.
I thought we were reviewing CPT not ICD here and I wholeheartedly apologize.
No worries, we are reviewing ICD, let's go "to the basics" here. What was the "reason for visit?" why is the patient in the in the OR? May I provide a fictional scenario here?
If a lumpectomy (Specimen A) was performed and all the margins (Specimen B, C, D, and E) were negative. You drive the final diagnosis. Pathology report states cancer, in situ, or otherwise for one specimen (Specimen A) and there isn't that finding in other specimens and those margins were inked and reviewed right (thankfully!!)? And as a pathology coder we "SERIOUSLY" get a moment to celebrate that operation and hopeful for our patient. As a Pathology Coder if the documentation states that specimen (Specimens B, C, D, and E) margins were reviewed. You CODE the findings on the patient's OVERALL pathology interpretation.
If this needs further discussion, please reach out to me in the AAPC "inbox" please. I am OOO next week and my replies will be irregular, but I will help you.
Narobo
Contributor
Assuming this is all from the same specimen (I.e. right breast), it’s appropriate to use DCIS as the ICD for the 88305’s
danachock
Expert
Narobo
Contributor
This was in reply to MrsSpiney's question
I don't have a case of my own that this applies to. Basing this off of text from the APF handbook itself in that not every specimen on a report needs to be separately ICD-10 coded if that specimen is malignant and all near-term efforts of the medical team will be directed at the patient's cancer. But again, this could change if not all specimens are from the same location!