Pathology Coding: do not Double Dip for Microdissection

Published: 21st March 2011
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Just-in CPT code 88363 is not the only code that describes prep work that a pathologist might carry out prior to molecular testing.

Code 88363 describes the work when a pathologist retrieves a signed-out case to choose proper tissue for molecular analysis. See to it that you know the difference between 88363 and codes from the following two code families.

Observe 88380-88381 bundles

Sometimes pathologists obtain target tumor cells for molecular analysis by using manual or laser capture microdissection techniques. You report the service using 88380 or 88381.

It is imaginable that a pathologist or one of his or her associates will choose archival tissue for a molecular analysis ordered by the patient's physician and then carry out microdissection on the archival tissue to prepare it for the test.

Be careful: Medicare's CCI bundles 88363 with 88380 or 88381. This means you should not bill the codes together when the pathologist chooses archive material and carries out microdissection for the same molecular analysis. It is reasonable to assume that CMS expects this bundle to apply as well to the situation where a colleague pathologist carries out the microdissection, even when that is done a day or two later.

Try this: Bill the code that represents the most wide-ranging documented service (say for instance 88381), which pays $184.15 versus 88363, which pays $38.05 (national non-facility total amount, conversion factor 33.9764).

Select 88387 Family or 88363.

Sometimes, pathologists carry out sterile macroscopic dissection to prep fresh tissue for molecular diagnostics testing. To capture the service, CPT provides the following two codes:

  • 88387 Macroscopic examination, dissection, and preparation of tissue for nonmicroscopic analytical studies (example, nucleic acid-based molecular studies); each tissue preparation (example, a single lymph node)

  • +88388 in conjunction with a touch imprint, intraoperative consultation, or frozen section, each tissue preparation (example, a single lymph node) (List separately in addition to code for primary procedure).

    For example: The pathologist might process a sentinel lymph node biopsy and provide distinct sterile macroscopic examination and sectioning for T or B clonality evaluation.

    Distinguish 88363: While preparing a specimen for molecular studies, 88387 and +88388 refer to specific pathologist macroscopic work that takes place before the pathologist carries out the microscopic examination. In contrast, 88363 takes place on archival tissue after the pathologist has finished the surgical pathology service and signed out the case.

    For more on this and for other specialty-specific articles to assist your pathology coding, sign up for a good medical coding resource like Coding Institute.

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