Wiki 88300 and 88304 same specimen

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RNCPC0709

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I have a provider that billed 88300 and 88304. I looked at the path report expecting to see two different specimens submitted. However, this was a tissue biopsy that contained a wood splinter. The provider is billing 88300 for the splinter and 88304 for the gross and micro on the tissue. Is this correct? I thought that the physician performing the procedure had to submit two separate containers? The fact that a foreign body is embedded in the tissue doesn't seem like you could bill a separate unit of 88300 for this. I can't find anything that addresses this specific scenario. Help please!:confused:

Thanks!
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PB
 
Really.....even an opinion would help!!!!!

Please help!!! Any path coder out there please help......even if it's a "best guess". I would really like some opinions on this before I have to send to the Medical Director.

Thanks!!!!

*******
PB
 
88300 and 88304

Okay, I'm not at all sure here, but:
In CPT 2009 Professional Edition pages 373-374 it states in the dialogue prior to the codes:
Service code 88300 is used for any specimen that in the opinion of the examining pathologist can be accurately diagnosed without microscopic examination.
88300-Level 1, surgical pathology, gross examination only

Service codes 88304 through 88309 describe all other specimens requiring gross and microscopic examination, and represent additional ascending levels of physician work.
88304-Level III, surgical pathology, gross and microscopic examination

This leads me to think the 88300 is included in the 88304 so would not be reported separately on the same specimen. Also, see below what CPT assistant has to say concerning multiple specimens.

Multiple pathological specimens
CPT Assistant, September 2000 Pages: 10,11 Category: Coding Consultation
Related Information
Surgical Pathology

Question

If two skin lesions are submitted together and are not separately identified, would this be reported as one or two specimens?

AMA Comment

The unit of service for the surgical pathology codes 88300-88309 is the specimen. A specimen is defined as tissue(s) that is (are) submitted for individual and separate attention, requiring individual examination and pathologic diagnosis.

Therefore, when material received for pathologic examination comprises multiple specimens, each specimen is considered a single unit of service and should be reported using a single code. For example, if two separate skin lesions are separately identified and submitted in a single container, the physician work related to each of these separately identified specimens would be reported as two units of service with code 88305. If, however, two separate skin lesions are submitted together and are not separately identified, then this would be reported as a single specimen as one unit of service with code 88305.




CPT Assistant © Copyright 1990–2009 American Medical Association. All Rights Reserved

Hope this helps!
 
I have unbundled a gross exam for a surgical device out of a specimen but not a splinter out of a debridement. I suppose it's possible to do this, but I have the feeling the splinter is incidental and I wouldn't do it.

In the case of the device, it's amply described down to serial numbers and such. What's to talk about with a splinter?
 
I'm in agreement with whaleheadking...I'm thinking just as an appendix can be incidental to certain colon specimens, the actual splinter is incidental to this specimen. I think it's overkill to charge a separate gross charge just for saying the splinter was included in the sample.
 
Thanks for the replies...

Thanks, everyone, for the responses!

I did recommend to the medical director that we uphold the incidental denial. He agreed, so looks like they're not getting paid for both.

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PB
 
I have bilateral tonsils that are submitted in one container with a pin clipping the right side from the left side, can 2 units be billed for this? They are billing 2 units of the 88304.
 
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