You Be the Coder:
Reporting Additional Work
Published on Sat Jun 01, 2002
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: We received an appendix with a pre-op diagnosis of appendicitis, but the pathologist's final diagnosis was neoplastic glandular proliferation. The pathologist evaluated nine blocks on the appendix. The specimen was far more complicated than usual. Is there any way to code for the extra work involved?
Tennessee Subscriber
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Answer: Regardless of the complexity of the specimen, the proper code is 88304 (Level III - Surgical pathology, gross and microscopic examination, appendix, other than incidental). Although the surgical pathology codes for gross and microscopic examination (88302-88309) "represent ascending levels of physician work," according to CPT 2002, they are also "specifically defined by the assigned specimens." In other words, a specimen that is listed under one of these codes should not be reported using any other of these codes. Do not upcode to the next level to capture the work of extra blocks or slides.
The only way to report the extra work is to use modifier -22 (Unusual procedural services). If you provide documentation of the extra work and submit a written request for compensation comparable to a higher surgical pathology code that represents the actual level of physician work, some payers will increase reimbursement for the service. However, Medicare and many other payers will not pay more for a procedure reported with modifier -22.
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