Pathology/Lab Coding Alert

Question: Our pathologist received two containers from surgery, one identified as "right prostate" and one identified as "left prostate." Each vial contained four prostate needle core biopsies. Should we report this as 88305 x 8, or 88305 x 2?

Louisiana Subscriber

Answer: You would properly code this case as 88305 x 2 (Level IV -- Surgical pathology, gross and microscopic examination; prostate, needle biopsy).

The reason you can't code 88305 x 8 is lack of documentation. You might expect 10 to 12 specimens for a conventional needle core biopsy, and you can appropriately bill 88305 for each separate needle core if you meet specific criteria. Those criteria are: the surgeon must separately identify each core (usually by location), and the pathologist must separately diagnose each piece of prostate tissue.

Because your case involves only two separately identified specimens, you can bill only 88305 x 2.

Caution: Medicare requires a different code when your pathologist examines tissue from a particular type of prostate sampling called "prostate saturation biopsy."

In these cases, the pathologist might examine as many as 40 prostate needle cores that the surgeon removed using stereotactic image guidance to create a template of sample locations. The results allow the surgeon to provide a map of the prostate gland and the tumor, if present. The surgeon will report this procedure as 55706 (Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance).

You should report the pathologist's work for these examinations for Medicare patients using one of the following codes instead of 88305:

• 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.