Monday, December 6, 2021

Pathology Corner: Surg Path Volumes That Disappear Due to Hospital Bundling

CPT codes 88302-88309 are the codes for a pathologist's work (before special stains) with anatomical specimens.   They're paid differently based on the size and complexity of the specimen, and the larger payments include more technical resources for blocks and slides.

The codes run from 88302 to 88309, skipping 88303 and 88306 and 88308, for historical reasons.  The numbers used, are titled from "Level II" to "Level VI".   For example, 88302 Level II includes "appendix, incidental," and 88309 Level VI includes total resection of the colon or pancreas.

Non-hospital specimens are paid "global" fees, if processed at one time and place.   Hospital specimens generally have the technical component bundled to the surgical center or hospitalization fee, and the only fee charged separately in Part B is the pathologist's interpretation fee on the prepared slides.  

As specimens become more complex, they are more and more likely to be inpatient specimens, so the global fee tends to disappear and the professional-fee-alone billing pattern becomes more common.  Let's see how it plays out.   

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Interestingly, it's a sort of inverted-U curve, with both 88302 and 88307-88309 being mostly professional fees and few global or technical fees.

Looking at total volume, the surg path codes are dominated by 88305, with few cases billed as lower or higher levels of service:

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