Forum - Questions & Answers

Dec 10th, 2009 - mafloyd

prostate bx

how many cores can you do during biopsy and get paid for by Medicare?

Dec 10th, 2009 - nmaguire   2,606 

core needle biopsy

CPT code 88305, surgical pathology, gross and microscopic examination, (example, 12 tissues samples on needle core biopsy). Needle core biopsies should be coded 88305 or 88307, depending on the source. Currently, the biopsies are reviewed by a pathologist and this service is captured under CPT code 88305, Surgical pathology, gross and microscopic examination, which is separately billed by the physician for each core sample taken. In its final rule implementing the 2009 Medicare Physician Fee Schedule, CMS published new HCPCS codes for reporting prostate saturation biopsies (G0416-G0419). Pathologists formerly reported these biopsies using CPT code 88305 once for each core sample obtained. Patients generally have 30 to 60 specimens taken for this type of biopsy. CMS believed that billing 88305 individually for the evaluation of each biopsy sample resulted in overpayment and have thus developed specific G to correct this issue. CMS may also have edits to restrict the units of service per day (MUE) for code 88305.

Dec 10th, 2009 -

For the urologist....

there is no code for "per core"- it is one procedure if they take 6 or 16.



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