G0416
Medicare requires you to code the G0416, G0417 etc. from the HCPCS codes. Yes, says it is for the saturation technique. No, they don't seem to care. You must use the G0416 whether it is saturation technique or not per NCCI edits. According to Dennis Padget, the pathology lab coding guru, "CMS effectively revised the descriptor on Jan. 1, 2012, although it did so without advance notice or publishing a formal revision to the descriptor anywhere." We have been waiting for a clarification from Medicare for about a year or more.
Here is what the descriptor should say,
"G0416 Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, regardless of biopsy approach (e.g., saturation or sextant or fiveregion), 10 to 20 specimens."
So, if you have 10 or less biopsies on a prostate:
88305 x # of prostate biopsies
For example 88305 x 6
If you have 10 or more biopsies on a prostate:
14 biopsies = G0416 x 1
You will only be reimbursed for 6 or 7 biopsies.
Also, you can only charge the 88342 on immunostains per stain rather than per antibody even if it is a prostate cocktail stain.
Hope this helps.