How To Use CPT Code 88325

CPT 88325 describes the comprehensive consultation provided by a qualified provider, typically a pathologist, with a review of records and specimens, and the preparation of a report on referred material. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 88325?

CPT 88325 can be used to describe a comprehensive consultation provided by a qualified provider, usually a pathologist, with a thorough review of records and specimens. The provider prepares a detailed report on the referred material, such as tissue blocks or slides. This code is used when a comprehensive analysis and evaluation of the referred material is performed, along with a report summarizing the findings.

2. Official Description

The official description of CPT code 88325 is: ‘Consultation, comprehensive, with review of records and specimens, with report on referred material.’

3. Procedure

1. A qualified provider, typically a pathologist, receives a request for a comprehensive consultation with referred material, such as specimen slides or tissue.
2. The provider reviews the full patient history, including surgical notes, radiology and laboratory results.
3. After a thorough examination of the slides and other submitted material, the provider prepares a report detailing the evaluation and opinion.

4. Qualifying circumstances

CPT 88325 is used when a comprehensive consultation is requested by another pathologist, surgeon, or clinician for a thorough analysis of the referred material. The provider must review the full patient history along with the tissues and slides to qualify for this code. It is important to note that the consultation should not occur during surgery, but rather after an initial diagnosis has been made.

5. When to use CPT code 88325

CPT code 88325 should be used when a comprehensive consultation is performed by a qualified provider, typically a pathologist, with a review of records and specimens. This code is appropriate when the provider thoroughly examines the referred material and prepares a detailed report summarizing the findings. It is important to ensure that the consultation does not occur during surgery, as there are separate codes for consultations performed during surgical procedures.

6. Documentation requirements

To support a claim for CPT 88325, the provider must document the following information:

• Request for a comprehensive consultation with referred material
• Full patient history, including surgical notes, radiology and laboratory results
• Thorough examination of the slides and other submitted material
• Detailed report summarizing the evaluation and opinion

7. Billing guidelines

When billing for CPT 88325, ensure that the consultation is comprehensive, with a review of records and specimens, and a report on the referred material. It is important to use this code only when the provider reviews the full patient history along with the tissues and slides. Additionally, be aware that some payers may have limitations on reporting CPT 88325 multiple times per patient per day, even if the provider consults on more than one surgical case.

8. Historical information

CPT 88325 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A pathologist providing a comprehensive consultation on a tissue sample from a patient with suspected cancer.
2. A qualified provider analyzing slides of a skin biopsy to determine the presence of a specific skin condition.
3. A pathologist reviewing records and specimens to provide a second opinion on a previous diagnosis made by another clinician.
4. A provider examining tissue samples from multiple body areas to assess the extent of a disease or condition.
5. A pathologist preparing a detailed report on the findings of a comprehensive consultation on a complex surgical case.
6. A qualified provider analyzing slides of a lymph node biopsy to determine the presence of abnormal cells.
7. A pathologist reviewing records and specimens to provide guidance on the appropriate treatment for a patient with a rare disease.
8. A provider examining tissue samples from different surgeries to identify any patterns or trends in the diagnoses.
9. A pathologist preparing a comprehensive report on the findings of a consultation requested by a surgeon for a complex surgical case.
10. A qualified provider analyzing slides of a bone marrow biopsy to assess the presence of abnormal cells or diseases.