Pathology/Lab Coding Alert

Question: If our rural hospital lab receives a biopsy specimen and performs accessioning, gross dictation, and tissue processing to send the specimen to another lab for diagnosis, which code describes our service?

Arkansas Subscriber

Answer: Based on your description, you probably don't have a chargeable service.

Although the work fits the description of 88300 (Level I - Surgical pathology, gross examination only), you can't unbundle that service from the biopsy exam (88305, Level IV - Surgical pathology, gross and microscopic examination, Breast, biopsy, not requiring microscopic evaluation of surgical margins).

Because you're sending the specimen to an outside lab for the 88305 service, your 88300 charge will come up against the 88305 charge with the same date of service and the claim will reject under the Correct Coding Initiative (CCI) edits.

Exception: If your lab does the full technical service of preparing the specimen for the 88305 exam -- imbedding the tissue in paraffin and sectioning and staining to prepare slides for the pathologist to interpret -- then you can charge for the technical component (88305-TC, Technical component) and the pathologist at the outside lab will charge for the professional component (88305-26, Professional component).

Consultation caution: Don't try to charge the 88300 for your lab and get the other lab to charge for a consultation on referred material (88323, Consultation and report on referred material requiring preparation of slides). The reference lab is not performing a consultation, because the specimen has never been previously diagnosed. The reference lab should charge 88305 for the service..