Follow These 3 Tips for Skin/Soft Tissue Coding
Published on Thu Sep 02, 2004
Use documentation to establish key points You've all faced it - pathology examination of a large excision that involves both the dermis and associated subcutaneous tissue and may require margin evaluation. Is it skin, or is it soft tissue? The answer could mean the difference between about $40 and $200, based on the Medicare Physician Fee Schedule for the following codes:
CPT 88304 - Level III - Surgical pathology, gross and microscopic examination, soft tissue, lipoma or skin - cyst/tag/debridement
88305 - Level IV - Surgical pathology, gross and microscopic examination, skin, other than cyst/tag/debridement/plastic repair or soft tissue, other than tumor/mass/lipoma/debridement
88307 - Level V - Surgical pathology, gross and microscopic examination, soft tissue mass (except lipoma) - biopsy/simple excision
88309 - Level VI - Surgical pathology, gross and microscopic examination, soft tissue tumor, extensive resection.
Use the following three tips to help you decide the proper specimen code: 1. Use Diagnosis to Determine Tissue Type The surgical note should provide some key information you need: What tissue was the surgeon going after? "The note might say, 'excisional skin biopsy,' 'lipoma,' or 'removal of soft tissue mass,' and you should use that information to narrow your code choice," says Elizabeth Sheppard, HT (ASCP), manager of anatomic pathology at Wake Forest University Baptist Medical Center in Winston Salem, N.C.
Tactic: You can use the narrative diagnosis or ICD-9 code to determine where the excised lesion originated. "For example, a squamous cell carcinoma may extend into subcutaneous tissue, but because squamous cell arises in the epithelium, you know that this is a skin specimen," says Pamela J. Biffle, CPC, CCS-P, ACS-DE, director of operations CustomCoding Books in the Dallas/Fort Worth area. The pathology report should confirm the specimen type.
ICD-9 codes for skin specimens might include 172.x (Malignant melanoma of skin), 173.x (Other malignant neoplasm of skin), and 216.x (Benign neoplasm of skin). You'd see different codes for soft tissue specimens, such as 171.x (Malignant neoplasm of connective and other soft tissue), 214.x (Lipoma), or 215.x (Other benign neoplasm of connective and other soft tissue). 2. Don't Let Size Fool You No matter how large or complex the specimen, skin is skin. "Even if a melanoma specimen extends into subcutaneous tissue, entails multiple cassettes, and requires margin evaluation, you still have to report 88305, ... skin, other than cyst/tag/debridement/plastic repair," Sheppard says. "You can't report 88307 for a skin specimen and call it a soft tissue mass just because it is a large, complex specimen that involves some soft tissue." 3. Consider the Pathologist's Work Even though size doesn't matter, you still have to consider the pathologist's work. "The complexity of the pathologist's exam can distinguish between codes, such as the difference between a [...]
