Pathology/Lab Coding Alert

Question: I've always billed multiple anatomic pathology services (such as 88300, 88305, 88307) with modifier 59, but it was brought to my attention that these codes aren't bundled. What is the current guideline for using modifier 59 with multiple anatomic pathology codes?

California Subscriber

Answer: You are correct that Medicare's Correct Coding Initiative(CCI) doesn't bundle the anatomic pathology codes 88300-88309. If the pathologist performs multiple pathology exams on multiple specimens for the same patient on the same date, with proper documentation, you can bill for each procedure without modifiers and expect full pay.

In your example, you could bill 88300 (Level I - Surgical pathology, gross examination only), 88305 (Level IV - Surgical pathology, gross and microscopic examination), and 88307 (Level V - Surgical pathology, gross and microscopic examination) without modifiers if the pathologist examined three distinct specimens, one at each of the service levels listed.

Caution: Some Medicare or other payers expect you to use modifier 59 (Distinct procedural service) with 88300 if you bill a gross exam with any other anatomic pathology code 88302-88309 to indicate that you're billing the gross exam of a separate specimen. Some payers also expect modifier 59 (or in some cases, 76, Repeat procedure or service by same physician or other qualified health care professional or 91, repeat clinical diagnostic laboratory test) if you're billing multiple units of one anatomic pathology code (such as two skin biopsies, one from the back and one from the left arm, each billed as 88305). Other payers want you to use units (88305 x 2). You should follow payer instruction in these instances.