To Boost Bottom Line Avoid Bundling Hysterectomy Specimens that Require Individual Diagnosis
Published on Sun Apr 01, 2001
Reporting by the book rather than with an under-standing of coding principles could result in anatomic pathology practices losing money. No cases highlight this problem better than coding for pathology examination of gynecological surgical specimens.
Capturing reimbursement for evaluating hysterectomy specimens requires knowledge of what constitutes a specimen, as well as an understanding of the patients clinical history and the final pathological findings, says R.M. Stainton Jr., MD, president of Doctors Anatomic Pathology Services, an independent pathology laboratory in Jonesboro, Ark.
Principles of Surgical Pathology Coding
Any surgical pathology service (88300-88309) includes accession, gross and microscopic examination (except 88300, which is gross only), and reporting of the findings and diagnosis to the treating physician. The codes describe a series of progressively more complex procedures for evaluating tissue pathology. Each code is considered a higher level of service than the preceding code (levels I through VI), meaning that more work is involved, and more reimbursement is expected. The unit of service for these codes is the specimen, and each code includes an extensive list of tissue types that would appropriately be assigned to that code. The specimen lists are based on the average amount of work for evaluating each type of tissue. Because they represent an average, pathologists may find any given evaluation to be more or less difficult than the norm. Despite that variation, pathology coders should report the appointed code, and assigning a specimen to a higher level of service because it was unusually large or difficult would be inappropriate, Stainton says.
For types of tissue that are not included in any specimen list, pathologists are to assign the code based on the amount of work involved in the examination. The level of work should be comparable to the work involved in evaluating other specimens listed for that code, Stainton says.
Properly Identify the Specimen
Many surgical pathology coding errors stem from the difficulty in determining what constitutes the specimen, says Stephen Yurco III, MD, partner and pathologist at Clinical Pathology Associates in Austin, Texas. These errors can involve either under- or over-reporting the service, he says. Undercoding can clearly cost a practice money, but so can upcoding if it means the practice is committing fraud.
CPT Codes states: A specimen is defined as tissue or tissues that is (are) submitted for individual and separate attention, requiring individual examination and pathologic diagnosis. If separate specimens are submitted from the same patient on the same day, then each should be assigned a separate code. That principle may be easy enough to apply if the separate [...]
