Hi, I have something to share on this scenario. Please do not assume that when a surgeon performs a brain biopsy that it "automatically warrants assigning procedure 88307”. Yes, you as the coder will ultimately provide both correct CPT and ICD code assignment based on each specimen received but please be cognizant of your CPT book.
Okay, there is no information provided on this scenario ~ so I will just hypothetically come up with a few scenarios for this discussion on familiar cases I have encountered when inaccuracies were encountered.
Let’s say the specimen’s final diagnosis is a benign neoplasm of the pituitary specimen that is assigned 88307 with dx D35.2. Your facility will probably be denied by a large majority of payors that the “diagnosis is inconsistent with the procedure”. Many of our insurance companies know that pituitary tumor is coded with 88305 from our CPT book.
Next example is a “biopsy of the brain” that ultimately turns out to be a blood clot received of the brain (so again I am unaware of the details of the actual findings) so I select I66.9 and then bill it with 88307 (but, per our CPT book the correct CPT assignment would be 88305 for “brain/meninges, other than for tumor resection”). Again, you would be denied payment for the same reason “diagnosis inconsistent with procedure”.
I am unsure if you work your own pathology denials, but this is what I see daily. I already know that when I see that denial reason – we are either going to probably correct the level of service or appeal the case with notes (pathology report). My philosophy has been to bill it correctly the first time, you eliminate the need for any corrections and simply appeal with the notes.
Thank you for listening & have a wonderful evening,
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT