CPT quiz

[ygdrasil]

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You recieve an oral cancer resection with bilateral neck dissections. The left side comes as three specimens divided by the surgeon into levels II, III, and IV. The right side comes as one specimen with levels II, III and IV still connected, but oriented by the surgeon. In addition to billing 88309 for the main specimen, for the neck dissections you also bill:

A) 88307x6 for grossing and evaluation of each lymph node region.
B) 88307x4, 3 for the divided left side, but only one for the connected right side.
C) 88307x2, because each side is a lymph node region.
D) Just the 88309, because the lymph node dissection is included in the charge for the main specimen.
E) You are happily nestled in an academic/hospital employee job and don't give a hoot about billing.

 

[pathstudent]

You recieve an oral cancer resection with bilateral neck dissections. The left side comes as three specimens divided by the surgeon into levels II, III, and IV. The right side comes as one specimen with levels II, III and IV still connected, but oriented by the surgeon. In addition to billing 88309 for the main specimen, for the neck dissections you also bill:

A) 88307x6 for grossing and evaluation of each lymph node region.
B) 88307x4, 3 for the divided left side, but only one for the connected right side.
C) 88307x2, because each side is a lymph node region.
D) Just the 88309, because the lymph node dissection is included in the charge for the main specimen.
E) You are happily nestled in an academic/hospital employee job and don't give a hoot about billing.

Wow that is a tough one.

I don't know if I am right, but I think I would feel most comfortable billing 88309x1 for the oral cancer and then 88307X4 for each container containing a regional lymph node dissection. But I could see an argument for an 88307x6 and 88307x2, but no way are neck dissections considered part of a composite resection the way the lymph nodes in a colon cancer case are! So I am going with B even though I wonder about A and C but I have eliminated D and E.

 

[ygdrasil]

It's a head-scratcher. In "Cracking the code: advice for CPT dilemmas" from 7/99 CAP says: "When multiple lymph node resections are dissected, each is examined separately to establish the presence and extent of metastases and each dissection is reported separately." Which is not explicit, but I think implies that you'd bill for each level separately: 88307 x 6.

 

[deleted314957]

left side--separately identified and separately submitted-three specimens-88307x3.
right side is one specimen-88307.
larynx is 88309.

 

[jp123ok]

left side--separately identified and separately submitted-three specimens-88307x3.
right side is one specimen-88307.
larynx is 88309.

Yes, I agree with mikesheree.

 

[yaah]

D. It's a bundle. A "radical resection of larynx" is supposed to include the nodes.

Not supposed to bill the larynx as 88309 unless the lymph nodes are with it.

That was what I was taught anyway. Some people still bill the 88307s and hope but I'm not sure if you collect it. See "bundling/unbundling" here: http://labmed.ascpjournals.org/content/42/4/242.full

Doesn't mean every payor is going to treat it the same way though.

 

[pathstudent]

D. It's a bundle. A "radical resection of larynx" is supposed to include the nodes.

Not supposed to bill the larynx as 88309 unless the lymph nodes are with it.

That was what I was taught anyway. Some people still bill the 88307s and hope but I'm not sure if you collect it. See "bundling/unbundling" here: http://labmed.ascpjournals.org/content/42/4/242.full

Doesn't mean every payor is going to treat it the same way though.

Doesn't make sense. If you got a laryngectomy with tumor and no neck dissection, you would bill 88309.

When you get a thyroid for tumor and separate neck dissections do you only bill 88307?

When you get a vulva with pelvic nodes, do you only bill for the vulva?

It makes sense with a colon as the nodes are integral to the specimen.

 

[yaah]

Doesn't make sense. If you got a laryngectomy with tumor and no neck dissection, you would bill 88309.

When you get a thyroid for tumor and separate neck dissections do you only bill 88307?

When you get a vulva with pelvic nodes, do you only bill for the vulva?

It makes sense with a colon as the nodes are integral to the specimen.

Because a laryngectomy without nodes is supposed to be an 88307. So I have read, anyway.

Thyroids are never 88309. Thyroid resection + regional nodes is 2 x 88307. The regional nodes in the neck are part of a radical laryngectomy thus are part of the 88309. Pelvic nodes are not part of a radical vulvectomy.

 

[2121115]

This answer depends on your geographic location and who your Medicare payor is. Private payers are a whole different ball game.

 

[Path or bust]

left side--separately identified and separately submitted-three specimens-88307x3.
right side is one specimen-88307.
larynx is 88309.

That's how I would bill.

 

[pathstudent]

This answer depends on your geographic location and who your Medicare payor is. Private payers are a whole different ball game.

No it doesn't. And Private insurers follow CMS rules about CPT codes.

 

[pathstudent]

That's how I would bill.

That's how I would have done it to, but I just looked up in my CPT manual published by the AMA and...

Larynx with tumor is an 88307.

Larynx with tumor and regional nodes is an 88309, so Yaah might be right. Not sure if you are forced to bundle neck dissections with a layngenctomy specimen like you are ovaries and uterus and tubes no matter if they are sent separately or not. But Yaah might be correct.

 

[Kunu]

left side--separately identified and separately submitted-three specimens-88307x3.
right side is one specimen-88307.
larynx is 88309.

Left side is correct
Right side is 309 x1 if it is submitted with the larynx, or
307 x2 (node dissec and larynx specimen) if they are submitted separately

 

[ygdrasil]

You'll note that in the OP I described merely an "oral cancer" specimen. I agree with Yaah that a laryngectomy with regional nodes is specifically bundled regardless of the number of buckets that are received (see also mastectomy with separately submitted axillary nodes = 88309 not 88307 x 2). But is it billed differently if it's a glossectomy and bilateral necks? A mandibulectomy? I think so, and it makes a big difference in my region, as (88307x2)/(88309x1) = 1.8