CPT Code 88305 | Description, Guidelines, Reimbursement & Examples
CPT Code 88305 is used to report Dissect Surgical Pathology. Anatomical pathology concerns with an examination of surgical specimens of tissues removed from living patients for the purpose of diagnosis of disease and guidance in the care of patients. Underneath the description are coding guidelines, reimbursement, and examples of CPT 88305.
CPT 88305 | Description & Explanation
In surgical pathology coding, specimens/containers, bundling/unbundling, lymph node regional resection, and tissue/procedure vs. diagnosis are the most challenging issues.
Description: “Level IV – Surgical pathology, gross and microscopic examinationAbortion – spontaneous/missedArtery, biopsyBone marrow, biopsyBone exostosisBrain/meninges, other than for tumor resectionBreast, biopsy, not requiring microscopic evaluation of surgical marginsBreast, reduction mammoplastyBronchus, biopsyCell block, any sourceCervix, biopsyColon, biopsyDuodenum, biopsyEndocervix, curettings/biopsyEndometrium, curettings/biopsyEsophagus, biopsyExtremity, amputation, traumaticFallopian tube, biopsyFallopian tube, ectopic pregnancyFemoral head, fractureFingers/toes, amputation, non-traumaticGingiva/oral mucosa, biopsyHeart valveJoint, resectionKidney, biopsyLarynx, biopsyLeiomyoma(s), uterine myomectomy – without uterusLip, biopsy/wedge resectionLung, transbronchial biopsyLymph node, biopsyMuscle, biopsyNasal mucosa, biopsyNasopharynx/oropharynx, biopsyNerve, biopsyOdontogenic/dental cystOmentum, biopsyOvary with or without tube, non-neoplasticOvary, biopsy/wedge resectionParathyroid glandPeritoneum, biopsyPituitary tumorPlacenta, other than third trimesterPleura/pericardium – biopsy/tissuePolyp, cervical/endometrialPolyp, colorectalPolyp, stomach/small intestineProstate, needle biopsyProstate, TURSalivary gland, biopsySinus, paranasal biopsySkin, other than cyst/tag/debridement/plastic repairSmall intestine, biopsySoft tissue, other than tumor/mass/lipoma/debridementSpleenStomach, biopsySynoviumTestis, other than tumor/biopsy/castrationThyroglossal duct/brachial cleft cystTongue, biopsyTonsil, biopsyTrachea, biopsyUreter, biopsyUrethra, biopsyUrinary bladder, biopsyUterus, with or without tubes and ovaries, for prolapseVagina, biopsyVulva/labia, biopsy”
Underneath the key processes involved in surgical pathology for accurate coding of CPT code 88305.
Examinations would be ordered as gross and microscopic pathology or gross and microscopic tissue exams.
- Histologic tissue sections are processed for microscopic viewing using either chemical fixation or frozen section.
- Frozen section processing involves freezing the tissue and generating thin frozen slices of the specimen mounted onto glass slides.
- Tissue is placed in a container that has the tissue source, preoperative diagnosis, and patient identification information labeled on it.
- Specimens from different locations must be submitted in separate containers, each labeled with the source of the tissue.
Phases Of Assignment
There are three main phases of CPT code 88305 assignment in surgical pathology.
Code Completion When The Pathologists’ Sign-Out
During code completion of CPT 88305, the billing manager must notify the pathologist of any discrepancy and the presence of all chargeable items coded in the final report.
(See Annex for Gross and microscopic examination of Lipoma)
The Pathologist’s Report
Specimen assessment, which includes the draft report after grossing and the final pathologists’ report, provides the ultimate CPT code. The ultimate CPT code is totally at the discretion of the pathologist’s report, although some discrepancies in reporting can be expected in some scenarios. If the add-on codes for additional procedures, special stains, and immunochemistry are not incorporated into the computer program, they should be included.
The Specimen’s Accession Preliminary Code
The primary goal of the specimen accession is to assign a unique surgical number for processing, diagnostic assessment, and filing based on the data provided in the requisition.
How To Bill CPT 88305
Services include accession, examination, and reporting. They do not include the services designated in codes CPT 88311 through CPT 88365 and CPT 88399, which are also coded when provided. The unit of service for code is the specimen.
A specimen is defined as tissue or tissues that is (are) submitted for individual and separate attention, requiring individual examination and pathologic diagnosis. Two or more such specimens from the same patient (eg, separately identified endoscopic biopsies, skin lesions) are each appropriately assigned an individual code reflective of its proper level of service.
Any unlisted specimen should be allocated to the code which most closely reflects the physician work involved compared to other specimens assigned to that code. For example, there is a larynx biopsy but no larynx polyp. Hence the code for larynx biopsy can be assigned.
Do not report 88305 CPT Code on the same specimen as part of Mohs surgery.
The pathologic analysis of the specimen is an inclusive component of Mohs surgery to be performed by the surgeon and should not be reported separately by him.
If the Mohs surgeon submits a specimen(s) derived from the procedure for pathologic examination to another physician (i.e., a pathologist) for either frozen (CPT 88329 – CPT 88334) or permanent section (CPT 88305), the pathologist is allowed to report his or her services, but the procedure no longer qualifies as Mohs surgery. The surgeon should report for excision and repair using the appropriate codes.
Underneath Medicare reimbursement for CPT 88305 for inpatient & outpatient visits, hospital services non and hospital-based outpatient providers.
Inpatients & Outpatients
CPT code 88305 is covered by Medicare when coded for inpatient and outpatient visits. The Medicare Part B Physician Fee Schedule covers the physician professional fee component. Coverage of the technical component is decided by the provider and patient setting.
Hospital Based Services
CPT Code 88305 can be reimbursed for hospital-based services. The technical component is bundled into prospective payment plans with a single fixed payment based on the diagnosis-related group (inpatients, Medicare Part A) or the Ambulatory Payment Classification (hospital-based outpatient services, Outpatient Prospective Payment System).
Non-Hospital Based Outpatient Providers
Reimbursement for 88305 CPT for non-hospital-based outpatient providers is as follows. The technical component is paid according to the Clinical Laboratory Fee Schedule under Medicare Part B.
The fee schedule for clinical laboratory tests will be based on median private payer rates.
- The technical component is billed on the date the specimen was collected. This would be the surgery date.
- When billing a global service, the provider can submit the professional component with a service date reflecting when the review and interpretation are completed or can submit the date of service as the date the technical component was performed. This will allow ease of processing for both Medicare and the supplemental payers.
- If the provider did not perform a global service and instead performed only one component, the date of service for the technical component would be the date the patient received the service, and the date of service for the professional component would be the date the review and interpretation is completed.
- When the collection spans two calendar dates, use the date the specimen collection ended.
Payment Under The Physician Fee Schedule (MPFS 2021)
|CPT 88305||CPT 88305 TC||CPT 88305 26|
|NON-FAC PE RVU||1.28||0.96||0.32|
|FACILITY PE RVU||1.28||0.96||0.32|
Below are two billing examples of CPT 88305.
One Container, two skin biopsies, one with a suture.
Billing: Units of Service = 2 units
Rationale: If the requisition confirms the significance of the suture (e.g., “sutured biopsy from right shoulder; second biopsy from right arm”), the physician work associated with each of these would be reported as two units of service.
A patient’s colonoscopy yielded three endoscopic biopsies. Each is in its own container, labeled with the place of origin (e.g., hepatic flexure, descending colon, and rectum).
Billing: CPT 88305 X3 Units
Rationale: Each is a separate specimen, and the physician service related to each would be coded as CPT Code 88305 (three service units).