# 88305 or 88307



## mannlx (Jul 22, 2010)

kidney soft tissue mass bx- dx is carcinoma
( do you code that as kidney bx =88305 or soft tissue mass bx = 88307)


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## tomtom2 (Jul 26, 2010)

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


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## whaleheadking (Jul 29, 2010)

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.


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## preserene (Aug 1, 2010)

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 *


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## tomtom2 (Aug 2, 2010)

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.


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## preserene (Aug 2, 2010)

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!!


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## tomtom2 (Aug 3, 2010)

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.


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## preserene (Aug 3, 2010)

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.


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## tomtom2 (Aug 3, 2010)

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.


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## whaleheadking (Aug 5, 2010)

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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## mannlx (Aug 6, 2010)

I love all that has happened, but my question was really this, if you have a mass growing on your kidney and you take a bx of that mass ( cancerous tumor) are you taking a biopsy of that site ( the kidney) or are you really just taking a biopsy of the tumor ( soft tissue mass) that grew on that site.

After reading Dennis Paget ( hopefully you have heard of him), he says go with the soft tissue only when you can more specifically go with the site so...
looks like 88302 (ha ha ha , just kidding, would have to go with 88305)


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## whaleheadking (Aug 8, 2010)

DP's the gold standard though we don't always agree.  That's more a matter of nuance than fundamentals.  It's not undifferentiated soft tissue, it's kidney despite what it may have morphed into.  That's why kidney bx is the best description.  Soft tissue applies when you have something that isn't otherwise defined by CPT (an organ usually).  It doesn't really matter if the mass is cancerous tumor or fibroma or bumpkiss, it's kidney in this case so you code 88305.

Yeah, who knew this would spin out the way it did?  All the threads should be like this.  We'd learn a lot more of what's going on outside our offices!!!


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## JEYCPC (Aug 12, 2010)

Before you throw the baby out with the bath water, (Carol Buck) read her pubkication for yourself.  You are stating you don't want to know her based on something someone else said.  

Also it's obvious that a kidney bx is an 88305.  Just read the CPT book.


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## whaleheadking (Aug 12, 2010)

Good advice, Just Another Coder.  I will check out Carol Buck to get it straight from the source. You're also right that if it's in CPT, that's the real gold standard.

Sound words we should all keep in mind.
Thanks,
WK


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## dparham (Aug 12, 2010)

*Kidney Mass BX*

Well, Carol Buck is well known to may seasoned coders.  she writes course books for several online schools.  I believe she works for the AMA.  Google her on the website.

I believe the level for this biopsy examination, no matter what title you give it, it is the services performed, the location, etc. that will determine the level.  This is definitely a higher level than 88305.


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## whaleheadking (Aug 18, 2010)

I googled her and realized that I've used her books for teaching.  88305.


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## mannlx (Aug 19, 2010)

I do tell my coders to go by the code books as the golden rule, but many times it does feel very wrong. An example of this would be when a pt has gallbladder cancer, and the pathologist sections the gallbladderand ends up with slides from A to ZZ( so now he is reviewing 48 slides) , this in no way should be 88304, but we code it that way just the same. ( i realize this codes probably work out better if you are a small path office, but when you are an extremely large practice, not so much)

have a great day.
and I two have both heard of and read carol buck, but not for pathology, but would like to see this.( what is the name of this book??)


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## whaleheadking (Aug 26, 2010)

Well, you have to remember that the codes don't describe the amount of work but the specimen at hand.  If it's a gallbladder, it's a gallbladder and CPT doesn't make any distinction.  It's like those big, deep skin excisions for invasive melanoma.  It's skin other than cyst, tag, debridement or repair.  It is what it is.  The codes are assigned for the average not the outlying difficult case.  The idea is, I think, that you get so many easy ones that are a snap that they'll pay for the hard ones that suck up a lot of time and resources.  

We always complain about the cancerous gallbladder and appendix (88304) but we're content with a soft tissue mass that turns out to be nothing (88307).  We're not reporting how many supplies and how much time and professional expertise we expend, only what we examine and diagnose.  It all comes out in the wash.

I agree.  Follow the code books literally and you'll never go wrong or worry during an audit.  Follow unofficial resources with caution no matter what credentials they have or how many books they've published.  Nobody is an expert when it comes to pathology coding because it's all fuzzy.  If you rely on CPT, you have at least one leg to stand on.

Cheers.
WK
http://pathcoder.blogspot.com


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## mannlx (Sep 2, 2010)

I totally agree !!!


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## wenkeck (Sep 2, 2010)

technically the mass is a soft tissue and its not the kidney being biopsied but rather the mass so i would use 88307


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