Laboratory Question for the Week of Decemeber 7, 2015

Laboratory Compliance Question of the Week

Question:

Should CPT code 88305 or HCPCS level II code G0416 be reported for surgical pathology on prostate biopsies? And how many units of service would be reported when there is one patient?

Answer:

The Centers for Medicare & Medicaid Services require that the following code be reported rather than CPT code 88305:
G0416 Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method

The 2016 edition of the National Correct Coding Initiative Manual states that CMS also requires that all submitted prostate needle biopsy specimens from a single patient be reported with one unit of service with this code.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.