Posted on 06. Dec, 2009 by in Toolkit
Busting the polyps’ “s” myth and identifying separately billable nasal specimens could add hundreds of dollars to a pathology claim. Make sure you’re not falling into two common coding traps by trying your hand at these two questions; then checking your answers.
Question 1: The lab receives the following tissue individually labeled by the surgeon: right septum polyp, left septum polyp, and left lateral nasal polyp. The pathologist microscopically examines representative portions of tissue from each sample and individually reports each specimen as “nasal polyps.” How should you code the case?
Question 2: The pathologist receives tissue in one container labeled “sinus contents and turbinates” for a patient with a clinical diagnosis of chronic sinusitis. The material consists of two strips of mucosal lining, bits of cartilage, and bony tissue that’s grossly consistent with turbinates. The gross description mentions decalcification of the bony material prior to embedding. The pathologist returns a microscopic diagnosis of “nasal mucocele cyst.”
What are the CPT and ICD-9 codes for this case?
Did you Lose $125? Check your quiz answers below to find out …
Answer 1: Because the surgeon separately identified, and the pathologist separately diagnosed, three distinct nasal polyp specimens, you should code this case as three units of 88304 (Level III — Surgical pathology, gross and microscopic examination, polyps, inflammatory — nasal/sinusoidal).
By avoiding the “plural” pitfall — erroneously assuming that “polyps” in the CPT code descriptor means you must bundle all polyps as one specimen — you avoid losing almost $125 for your practice (based on 2009 physician fee schedule national non-facility total global relative value units).
Answer 2: You should charge this case using a single CPT code for the gross and microscopic pathology exam. Because “sinus contents” is an...
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