Pathology/Lab Coding Alert

Question: I'm new to pathology coding, and I see codes such as 88305 with modifier 76. I've been told it's for "multiple units," but shouldn't I just bill the code x number of units?

Illinois Subscriber

Answer: There's no hard and fast rule about how to bill when your pathologist legitimately examines multiple surgical pathology specimens from the same patient on the same day -- you'll need to follow individual payer instructions.

For instance: If the pathologist examines a skin lesion from the left forearm and a skin lesion from the right calf, the pathologist's service is two separate instances of 88305 (Level IV -- Surgical pathology, gross and microscopic examination, skin, other than cyst/tag/debridement/plastic repair).

Depending on your payer, you might fill out the claim form various ways, as follows:

• 88305 x 2 -- Some payers accept units, and that's all you need to report.
• 88305 and 88305-59 (Distinct procedural service) -- Some payers want to see modifier 59, which is how you indicate that the two units of 88305 represent "a different session, different procedure or surgery, different site or organ system, separate incision/excision, or separate lesion" (from CPT Appendix A modifier 59 description).
• 88305 and 88305-76 (Repeat procedure or service by same physician). Although payers rarely ask for this modifier in the context of multiple surgical pathology specimens, some do. They're essentially using it like modifier 59 -- as a way for you to indicate that the pathologist actually performed two distinct services.

Only use modifier 76 in this context if your payer insists, because modifier 59 more accurately describes the scenario.