Pathology/Lab Coding Alert

Answer: No, you should not use G0416 (Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method, 10-20 specimens) when your pathologist examines six prostate biopsy specimens. Instead, you should report six units of 88305 (Level IV - Surgical pathology, gross and microscopic examination, …Prostate, needle biopsy…). 

 

If the pathologist examines 10 or more prostate biopsy specimens taken by any surgical method or approach, and the payer is Medicare, then you should use G0416, G0417 (... 21-40 specimens), G0418 (... 41-60 specimens), or G0419 (... > 60 specimens).

 

That’s a change from past years when Medicare requested those codes for prostate saturation biopsy specimens only. Now you should choose 88305 or G0416 and beyond based strictly on specimen number and payer.

 

Many non-Medicare payers still don’t recognize the “G” codes and expect you to report each prostate biopsy as a single unit of 88305.

 

Possible confusion: Medicare issued Transmittal 2912 and MLN Matters article MM8664 in March 2014 containing a typographical error in the code definition of G0416 that identified the code as 1-20 biopsies instead of 10-20 biopsies. If your question is based on reading this information, please note that CMS has corrected the error.