[Histonet] Major skin resections - CPT coding

[Joe W. Walker, Jr.]

Hi Dr. Cartun,

We have had similar discussions about this in our institution, too.  Unfortunately, according to our contracted lab compliance person, the correct code for all skin lesions is 88305.

Below is an excerpt from Dennis Padget's coding manual (now owned by American Pathology Foundation) that provides information related to this topic:
" Popular urban legend has it that it’s okay to report large or complex skin specimens—wide excisions, melanomas, and basal cell or Merkel cell with margins immediately come to mind—at the 88307 or 88309 charge level. Although these specimens unquestionably involve more work than lesser samples, what can’t be disputed is that they’re still very much accurately described by the label Skin, other than cyst/tag/debridement/plastic repair. Hence, you should ignore these myths. For added information on this important topic, refer to section 3 of chapter 7.) Report code 88305 unconditionally for a skin specimen diagnosed as other than a plastic repair, debridement, cyst, or tag. You can’t change the code based on the clinical diagnosis, pathologic diagnosis (other than to rule out the 88302 and 88304 categories), number of blocks or slides, a complication, or an extenuating circumstance." (APF, 2016, p.245)

American Pathology Foundation. (2016). Pathology coding handbook (Ver. 16.3). Laguna Beach, CA: American Pathology Foundation.

Joe W. Walker, Jr. MS, SCT(ASCP)
Anatomical Pathology Manager
joewalker at rrmc.org, www.rrmc.org

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Sent: Thursday, July 25, 2019 4:48 PM
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Subject: [Histonet] Major skin resections - CPT coding

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I'm curious; how do you code major (complex) skin resections that also include soft tissue?  These cases often have 10-30 paraffin blocks and lots of H&E slides.  I'm thinking that they could be coded 88307 (simple resection) or 88309 (complex resection).  I found out that our Dermatopathologist was coding these as "88305" and I don't think that is appropriate.  Thank you in advance for your comments.

Richard

Richard W. Cartun, MS, PhD
Director, Histology & The Martin M. Berman, MD Immunopathology/Morphologic Proteomics Laboratory Director, Biospecimen Collection Programs Assistant Director, Anatomic Pathology Hartford Hospital
80 Seymour Street
Hartford, CT  06102
(860) 972-1596 (Office)
(860) 545-2204 (Fax)
Richard.cartun at hhchealth.org<mailto:Richard.cartun at hhchealth.org>


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