Pathology/Lab Coding Alert

Recognize when multiple units can help your bottom line.

TUR, saturation, needle, subtotal --" don't let these words lead you astray. Instead, follow our five expert tips to pick the right CPT code for your prostate pathology tissue specimens, every time.

1: Review the Codes

You can't code all prostate specimens the same. In fact, CPT provides four different options to describe pathology prostate tissue exams. That's why the first step in picking the right code is knowing your choices, as follows:

- 88305 --" Level IV - Surgical pathology, gross and microscopic examination; prostate, needle biopsy

- 88305 --" prostate, TUR

- 88307 --" Level V - Surgical pathology, gross and microscopic examination; prostate, except radical resection

- 88309 --" Level VI - Surgical pathology, gross and microscopic examination; prostate, radical resection.

2. Remember That Radical Means Total

When the surgeon submits the entire prostate gland, you should report 88309. A total prostate-resection specimen almost always includes attached seminal vesicles, according to Stephen Yurco III, MD, partner and pathologist at Clinical Pathology Associates in Austin, Texas.

Don't unbundle: You shouldn't separately report the seminal vesicles or other incidental tissue that the surgeon might submit attached to the prostate, such as fatty tissue, the prostate/bladder neck junction, and a small vas deferens section.

3. Know These -Except Radical- Characteristics

Using -except- in the 88307 prostate specimen description is appropriate -- you-ll often select this code based on a process of elimination of what the tissue is not.

Not TUR: Although an 88307 prostate specimen is a piece (or two) of prostate tissue, it is not a piece obtained from a needle, nor multiple small pieces obtained from the surgeon's transurethral resection (TUR).

Not total: If the pathologist examines a relatively large piece of prostate tissue that doesn't include any secondary tissues such as seminal vesicles, you do not have an 88309 specimen. Instead, when the surgeon removes much of the prostate in one or two large pieces and leaves the seminal vesicles and other nearby tissues intact, you have an 88307 prostate resection specimen.

Exception: You might receive a separate lymph node resection with an 88307 prostate specimen. That doesn't mean you should report the prostate as 88309 -- that means you should report the regional lymph nodes in addition to the 88307 prostate specimen. List the lymph nodes as an additional unit of 88307 (- lymph nodes, regional resection).

Look for these terms: Certain terms in the surgical or pathology reports might tip you off to use 88307 for the specimen. If the pathologist calls the specimen a -subtotal prostatectomy,- report 88307. If the surgeon describes a surgical approach such as perineal, suprapubic, or retropubic, for example, the prostate specimen is usually a subtotal resection.

4. Don't Report Multiple TURs

A prostate TUR (also called TURP, for transurethral resection of prostate) is a prostate resection specimen that the surgeon acquires via a -transurethral- surgical approach. The technique involves using a cystoscope with a cutting loop to excise bits of tissue and cauterize the excision site.

Many small pieces: Based on the surgical procedure, you can understand why the prostate TUR specimen is made up of many small pieces of prostate tissue.

Avoid confusion: Although this is a partial resection specimen, you should not use 88307 (prostate, except radical resection). Instead, you should report the more specific code -- 88305 (prostate, TUR). -You should report 88305 even though pathologists often find the TURP specimen to be more work than the tissue exam from an open partial prostatectomy,- says R.M. Stainton Jr., MD, president of Doctors- Anatomic Pathology Services in Jonesboro, Ark.

Just one specimen: Even though the pathologist may receive many individual pieces of prostate tissue from a TUR procedure, you should report one unit of 88305, regardless of the number of blocks.

5. Do Report Multiple Biopsies

When the pathologist examines a needle core specimen from the prostate gland, you should report the procedure as 88305 (- prostate, needle biopsy). Note that the needle biopsy is at the same pathology service-level (88305) as a prostate TUR, but a needle core and TUR are not the same specimen.

Identify separately, code separately: Unlike a TURP, you can report multiple units of 88305 in some cases. If the pathologist separately receives and diagnoses multiple pieces of prostate tissue from multiple needle biopsies, you should report 88305 for each. If the surgeon submits multiple biopsies in a single container with no distinguishing marks, however, you should stick to one biopsy charge (88305).

Yes, even -saturation- biopsies stand alone: CPT 2006 introduced a Category III code to describe a surgical procedure for prostate called -saturation- biopsy (0137T, Biopsy, prostate, needle, saturation sampling for prostate mapping). The procedure involves extracting biopsy cores that the physician specifically locates on a grid so that she can -map- the extent of tumor following biopsy diagnosis. According to the AMA's CPT Changes 2006, An Insider's View, -typically a total of 20 to 40 cores are taken.

-Should you code each of these prostate biopsy specimens as 88305? Yes. -The AMA confirms that 20, 30, or even 40 individual cores from a prostate saturation biopsy procedure are individually billed (e.g., 88305 x 40) when each is individually diagnosed,- according to Pathology Service Coding Handbook*.

Follow payer guidelines: If the case justifies reporting multiple prostate biopsies, you should follow your payer instruction to do so. Many payers ask that you report units (for example, 88305 x 12) while some ask that you report subsequent codeswith modifier 59 (Distinct procedural service) or rarely, 76 (Repeat procedure by same physician).

* Editor's note: Coding advice from Pathology Service Coding Handbook, version 8.2, by Dennis Padget, published quarterly by DLPadget Enterprises Inc. was instrumental in writing this article.