Missing multiple 88304 specimens could cost your practice $125.
Busting the polyps’ “s” myth and identifying separately billable nasal specimens could add hundreds of dollars to a pathology claim. Make sure you’re not falling into two common coding traps by trying your hand at these two questions; then checking your answers.
Question 1: The lab receives the following tissue individually labeled by the surgeon: right septum polyp, left septum polyp, and left lateral nasal polyp. The pathologist microscopically examines representative portions of tissue from each sample and individually reports each specimen as “nasal polyps.” How should you code the case?
Question 2: The pathologist receives tissue in one container labeled “sinus contents and turbinates” for a patient with a clinical diagnosis of chronic sinusitis. The material consists of two strips of mucosal lining, bits of cartilage, and bony tissue that’s grossly consistent with turbinates. The gross description mentions decalcification of the bony material prior to embedding. The pathologist returns a microscopic diagnosis of “nasal mucocele cyst.”
What are the CPT and ICD-9 codes for this case?
Did you Lose $125? Check your quiz answers below to find out …
Answer 1: Because the surgeon separately identified, and the pathologist separately diagnosed, three distinct nasal polyp specimens, you should code this case as three units of 88304 (Level III — Surgical pathology, gross and microscopic examination, polyps, inflammatory — nasal/sinusoidal).
By avoiding the “plural” pitfall — erroneously assuming that “polyps” in the CPT code descriptor means you must bundle all polyps as one specimen — you avoid losing almost $125 for your practice (based on 2009 physician fee schedule national non-facility total global relative value units).
Answer 2: You should charge this case using a single CPT code for the gross and microscopic pathology exam. Because “sinus contents” is an unlisted specimen, you’ll bill this service based on the physician work involved, compared to similar specimens. The AMA and the College of American Pathologists (CAP) advise comparison to 88305 (Level IV — Surgical pathology, gross and microscopic examination, sinus, paranasal biopsy).
You can’t, under the described circumstances, legitimately break this nasal contents specimen into component parts of nasal turbinate, nasal cartilage, and nasal mucosa.
The surgeon didn’t separately identify the components, but, more importantly, the pathologist provides only a single diagnosis.
Missed opportunity: Had the pathologist reported “sinus contents: nasal mucocele cyst” and “turbinates: unremarkable nasal turbinates” as the final diagnosis instead of just the former, you’d report 88305 and 88304, respectively, for this case. The pathologist can uniquely distinguish the turbinate tissue from the other material via histologic feature difference, so reporting two codes would be justified, even though all the material arrived in one container, according to Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc., publisher of Pathology Service Coding Handbook in The Villages, Fla.
Caution: “You should always be careful not to unbundled a single pathology specimen,” says R.M. Stainton Jr., MD, president of Doctors’ Anatomic Pathology Services in Jonesboro, Ark. Some pathologists choose not to break out a separate specimen if the surgeon doesn’t identify it.
But CPT coding instruction for surgical pathology identifies the specimen (the unit of service for codes 88300-88309) as tissue(s) that require “individual examination and pathologic diagnosis.” Instructions for the surgical pathology codes also state: “Two or more such specimens from the same patient are each appropriately assigned an individual code reflective of its proper level of service.”
Capture ancillary service: If you forget to report the decalcification (+88311, Decalcification procedure [List separately in addition to code for surgical pathology examination]) — a common error — you stand to lose $18 of legitimate pay for your practice (based on 2009 physician fee schedule national non-facility total global RVUs).
Code final diagnosis: Although the referring physician submitted the specimen with a clinical diagnosis of chronic sinusitis (473.9, Unspecified sinusitis [chronic]), you should code the case based on the pathologist’s findings. That means you should report the diagnosis as 478.19 (Other diseases of nasal cavity and sinuses, cyst or mucocele of sinus [nasal]).
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