Pathology/Lab Coding Alert

Question: What is the specimen number cutoff for using prostate saturation biopsy "G" codes versus 88305 for multiple prostate biopsies for Medicare patients?

Florida Subscriber

Answer: Specimen number does not distinguish when you should report multiple prostate needle biopsies for a Medicare beneficiary using multiple units of 88305 (Level IV -- Surgical pathology, gross and microscopic examination, prostate, needle biopsy) versus one of the following "G" codes:

• G0416 -- Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling; 1-20 specimens
• G0417 -- ... 21-40 specimens
• G0418 -- ... 41-60 specimens
• G0419 -- ... greater than 60 specimens.

Rather, the distinction depends on the surgical procedure.

Do this: You should only report the "G" codes for the pathologist's interpretation if the surgeon performs a prostate saturation biopsy procedure (55706, Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance). Then you should select the appropriate HCPCS Level II code to describe your pathologist's work based on the number of specimens. The prostate saturation biopsy procedure involves the surgeon "mapping" the exact location of each biopsy sample using imaging guidance.

Prostate biopsy per specimen: Aside from the prostate saturation biopsy procedure, if the surgeon extracts multiple prostate needle biopsies and separately identifies each for distinct examination and diagnosis by the pathologist, you should report 88305 once for each distinct prostate biopsy specimen. Prostate biopsies often involve about 12 separate needle cores, so reporting multiple units of 88305 would not be unusual in this scenario.

Example: The surgeon submits 12 specimens from a prostate saturation biopsy for a Medicare beneficiary.

Solution: Code the scenario as G0416. If the distinct specimens were not from a prostate saturation biopsy, you would report the service as 88305 x 12.