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Q: Should we use CPT code 88305 or 88307 for skin excision with suture orientation for melanoma or basal cell cancer?
A. Skin is not a listed specimen under CPT code 88307. All skin specimens other than cysts, tags, debridements, and plastic repairs are coded as 88305, Level IV-surgical pathology, gross and microscopic examination, skin, other than cyst/tag/debridement/plastic repair, regardless of difficulty. Unless specified in CPT, it is not appropriate to upcode for neoplastic diagnoses or unusually large specimens.
Q: What is the proper way to report services for hospice patients? A pathologist examined a nasal skin lesion for a Medicare patient with hospice coverage and rendered a diagnosis of basal cell carcinoma with free margins. (No frozen section was performed.) The service was billed as 88305-26. The local Medicare carrier rejected the claim, stating the patient was enrolled in hospice and qualified for hospice care.
A. Patients with a terminal illness and a life expectancy
of no more than six months can choose standard Medicare coverage or hospice
care. If a patient is enrolled in hospice care, one of two modifiers must
be used with the service rendered by a nonhospice physician. Modifier
GV should be used if the service provided by the nonhospice-affiliated
physician is related to the terminal condition. Modifier GW should be
used for services unrelated to the terminal condition.
The appropriate code for the aforementioned service
is 88305, Level IV-surgical pathology, gross and microscopic examination,
skin, other than cyst/ tag/ debridement/ plastic repair, with modifier
-26 (professional component) and modifier GW appended.
Frequently asked questions about CPT are published bimonthly in “Capitol
Scan.” This section of CAP TODAY is a product of the CAP Economic
Affairs Committee.
The codes and descriptions listed here are from Current Procedural
Terminology, 4th ed., CPT 2006. CPT 2006 is copyrighted by the American
Medical Association. To purchase CPT books, call the AMA at 800-621-8335.
For more information about CPT coding, visit the CPT
Coding Resource Center on the CAP Web site.
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