Fallopian tubes

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homer315

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Almost all of our tubes that come out for sterilizations these days are complete or partial salpingectomies rather than transections. Our biller still uses 88302 ($7 PC), but I am wondering if 88035 ($36) would be more appropriate given the increased work that comes with examining a full tube for STIC and the fact that these surgeries are not done exclusively for sterilization but for cancer risk reduction. Ovaries and tubes in BRCA patients are 88305s. For our group, the difference would mean over $50k annually.

So anyone upcoding and getting away with it?
 
I don't think so.
You would have to have documentation the surgery was done to reduce BRCA risk by the surgeon.
Bigger question. It everyone submitting everything? It started for a couple of years, saw nothing and stopped.
 
homer315 said:
Almost all of our tubes that come out for sterilizations these days are complete or partial salpingectomies rather than transections. Our biller still uses 88302 ($7 PC), but I am wondering if 88035 ($36) would be more appropriate given the increased work that comes with examining a full tube for STIC and the fact that these surgeries are not done exclusively for sterilization but for cancer risk reduction. Ovaries and tubes in BRCA patients are 88305s. For our group, the difference would mean over $50k annually.

So anyone upcoding and getting away with it?
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Well, if you are so inclined to upcode, just add a p53 and Ki-67 IHC to each Fallopian tube if STIC is such a clinical concern for your clinicians.
 
homer315 said:
So anyone upcoding and getting away with it?
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No. But, good luck if you try and report back with the results.
AZpath said:
Found this interesting Population Frequency of Serous Tubal Intraepithelial Carcinoma (STIC) in Clinical Practice Using SEE-Fim Protocol
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Of 354 risk-reducing surgeries, STIC was identified in 5 (1.4%), including three with benign findings and two related to HGSC (one tubal and one endometrial) (Supplementary Table 1, available online). - The juice ain't worth the squeeze imo...
 
I would sign out as “Prophylactic salpingectomy in high risk (BRCA+) patient: Negative for dysplasia or malignancy.

Comment: The entire specimen has been examined histologically.

I think that verbiage clearly justifies 88305.
 
mikesheree said:
I would sign out as “Prophylactic salpingectomy in high risk (BRCA+) patient: Negative for dysplasia or malignancy.

Comment: The entire specimen has been examined histologically.

I think that verbiage clearly justifies 88305.
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BRCA+ tubes are clearly 88305s and all of ours are coded as such. My question is whether total salpingectomies done with the dual purpose of sterilization and cancer risk reduction in wild type individuals deserve a 305 rather than a 302 given the amount of extra effort involved in the examination.
 
homer315 said:
BRCA+ tubes are clearly 88305s and all of ours are coded as such. My question is whether total salpingectomies done with the dual purpose of sterilization and cancer risk reduction in wild type individuals deserve a 305 rather than a 302 given the amount of extra effort involved in the examination.
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Prophylaxis in a patient without any known risk factors.....who desires sterilization ? I cannot see an 88305. Nor can I see a total salpingectomy justified in that clinical setting, but that’s the surgeon’s (perhaps monetary) call.
 
mikesheree said:
Prophylaxis in a patient without any known risk factors.....who desires sterilization ? I cannot see an 88305. Nor can I see a total salpingectomy justified in that clinical setting, but that’s the surgeon’s (perhaps monetary) call.
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All our GYN surgeons are doing full salpingectomies now instead of simple tubal ligations. But nothing on the reqs notes it is for cancer evaluation, it just seems to be their new standard of care. We only charge 88302, and we only bisect the fimbriated end and submit that w/ one or two tube cross sections. We do not do full SEE-FIM protocol on these, usually just one block per tube.
 
mikesheree said:
Prophylaxis in a patient without any known risk factors.....who desires sterilization ? I cannot see an 88305. Nor can I see a total salpingectomy justified in that clinical setting, but that’s the surgeon’s (perhaps monetary) call.
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Yeah sounds to me like an insurance move. Either more $$$ for the surgeon or so the patient is covered. Our GYN's are not doing totals except for BRCA.
 
there is data supporting “opportunistic salpingectomy” in non BRCA women lowers the lifetime risk of tubo-ovarian serous cancer. it makes sense if your desiring sterility to do salpingectomy rather than ligation or removing the uterus for a benign reason to also take the entire FTs too

If the indication for the salpingectomy is sterility your stuck with the 302.
 
I’ll bet totals aren’t happening in inner city medicare or uninsured areas. This is all about $.
 
mikesheree said:
I’ll bet totals aren’t happening in inner city medicare or uninsured areas. This is all about $.
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It does not pay any differently from a traditional tubal (I am private practice ob/gyn with large medicaid patient base). We do it because it is recommended for ovarian cancer risk reduction by ACOG. Not everyone keeps their practice up to date, which is probably where you are seeing the difference. It's definitely not about money.
 
bikelady said:
It does not pay any differently from a traditional tubal (I am private practice ob/gyn with large medicaid patient base). We do it because it is recommended for ovarian cancer risk reduction by ACOG. Not everyone keeps their practice up to date, which is probably where you are seeing the difference. It's definitely not about money.
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Burn...🔥
 
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