Pathology/Lab Coding Alert

Question: I'm getting conflicting instructions about how to report multiple units of "like" specimens, such as two skins. Should I use a modifier, and if so, which one?

Texas Subscriber

Answer: For multiple units of "like" specimens, such as "two skins," you should report the code times the units, for most payers. For instance, for two distinct nevi, report 88305x2 (Level IV - Surgical pathology, gross and microscopic examination, skin, other than cyst/tag/debridement/plastic repair). In fact, you'd report any two 88305 specimens with the same date of service as 88305x2, even if they're not "like" specimens, such as a skin cancer excision and a lymph node biopsy (88305, ... lymph node biopsy).

Obey payer rules: Although using units is common, some payers don't want you to list a single code with units for surgical pathology specimens from the same level of service. Instead, they may require you to report subsequent specimens after the first at that service level using a modifier. Some payers require modifier 59 (Distinct procedural service), while a few require modifier 76 (Repeat procedure or service by the same physician or other qualified health care professional).

Compliance tip: Keep a copy of your payers' written instruction regarding these scenarios, and consistently follow payer rules for multiple units to ensure accurate and timely pay.