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| Section: |
Laboratory |
| Number: |
L-8 |
| Topic: |
Surgical (Anatomic) Pathology |
| Effective Date: |
August 1, 2005 |
| Issued Date: |
August 1, 2005 |
| Date Last Reviewed: |
08/2005 |
General Policy Guidelines
Indications and Limitations of Coverage
Surgical pathology codes should be processed as reported.
Consultation during surgery with or without frozen section is payable separately under codes 88329-88332. When multiple frozen sections are reported, the first procedure should be paid under code 88331. Additional frozen sections should be combined under code 88332 with the appropriate multiplier.
Description
Procedure codes 88300-88309 designate surgical pathology studies. A specimen is defined as tissue or tissues that is (are) submitted for individual and separate attention, requiring individual examination and pathologic diagnosis.
Code 88300 represents any specimen that in the opinion of the examining pathologist can be accurately diagnosed without microscopic examination. Code 88302 is used when gross and microscopic examination is performed on a specimen to confirm identification and the absence of disease. Codes 88304-88309 represent all other specimens requiring gross and microscopic examination, and represent additional ascending levels of physician work. Levels 88302 through 88309 are specifically defined by the assigned specimens. |
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Procedure Codes
| 88300 | 88302 | 88304 | 88305 | 88307 | 88309 |
| 88329 | 88331 | 88332 | | | |
Traditional Guidelines
FEP Guidelines
PPO Guidelines
Managed Care POS Guidelines
Publications
PRN References
05/1994, Surgical pathology, reporting
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References
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Table Attachment
Text Attachment
Procedure Code Attachment
Glossary
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This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.
Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.
Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.
Mountain State Blue Cross Blue Shield (MSBCBS) retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of MSBCBS. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.
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