Wiki Correct Colposcopy with Biopsy Coding

[aspangl2]

I had a colposcopy with biopsy performed. The provider who performed the procedure billed 99213, 57454, and 88305 x 2. The pathologist submitted a separate claim for 88305. All conversations I had with the provider on that DOS were related to the colposcopy and what to expect from the procedure. A separately identifiable E&M was not performed. The provider states their billing is correct and the billing of 88305 was for the slide prep. I do not believe this is correct. I believe the correct coding for the physician who performed the colposcopy with biopsy should only be 57454 and the pathologist should be the only provider billing for the 88305 x 2. What is the correct coding for this scenario?

 

[CBLENNIE]

I work for an insurance company and we recently had an issue with a group of docs billing for the 88305-TC for the slide prep and then the pathologist was only billing the 88305-26, which would be appropriate if they each did the individual work involved in these processes. If both the doc performing the procedure and the pathologist are billing the global 88305, meaning no TC or 26 modifiers, then you definitely have an issue with double billing on the pathology code.

You might call your insurance company and report that there was potentially incorrect coding of the 99213 and ask for it to be reviewed by the fraud, waste and abuse or payment integrity departments to see if you can get them to audit your claim for this service.

 

[LisaAlonso23]

I had a colposcopy with biopsy performed. The provider who performed the procedure billed 99213, 57454, and 88305 x 2. The pathologist submitted a separate claim for 88305. All conversations I had with the provider on that DOS were related to the colposcopy and what to expect from the procedure. A separately identifiable E&M was not performed. The provider states their billing is correct and the billing of 88305 was for the slide prep. I do not believe this is correct. I believe the correct coding for the physician who performed the colposcopy with biopsy should only be 57454 and the pathologist should be the only provider billing for the 88305 x 2. What is the correct coding for this scenario?

I agree with the above response. Was the colposcopy decided at a previous visit? If so, the E/M definitely shouldn't have been billed with the procedure.

 

[Cmama12]

I had a colposcopy with biopsy performed. The provider who performed the procedure billed 99213, 57454, and 88305 x 2. The pathologist submitted a separate claim for 88305. All conversations I had with the provider on that DOS were related to the colposcopy and what to expect from the procedure. A separately identifiable E&M was not performed. The provider states their billing is correct and the billing of 88305 was for the slide prep. I do not believe this is correct. I believe the correct coding for the physician who performed the colposcopy with biopsy should only be 57454 and the pathologist should be the only provider billing for the 88305 x 2. What is the correct coding for this scenario?

The same thing happened to me a number of years ago. I had too much going on to try to fight it - she had billed a consult and there was definitely no discussion about anything. I came in, she explained what was going to happen and that was it.

If the colpo was previously scheduled, and you didin't discuss anything else, there should not be a separate e&m. There are some doctors who routinely add an office visit to everything
Also did she just do a biopsy or both a biopsy and ECC? If it was only the biopsy, it should be 57455