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Pathology/Lab Coding Alert

Reader Question:

Surgical Procedure Determines Pathologist Prostate Work

Published on Mon Oct 10, 2011

Question: What is the specimen number cutoff for using prostate saturation biopsy "G" codes versus 88305 for multiple prostate biopsies for Medicare patients? Florida SubscriberAnswer: 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 specimensG0417 -- ... 21-40 specimensG0418 -- ... 41-60 specimensG0419 -- ... 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 [...]
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