You Be the Coder :
Counting Won't Predict Proper Prostate Code
Published on Sat Jul 25, 2009
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 [...]