Summary & Overview
CPT 88304: Surgical Pathology, Level III Gross and Microscopic Examination
CPT code 88304 is a nationally recognized billing code for Level III surgical pathology, encompassing both gross and microscopic examination of tissue specimens. This procedure is fundamental in the diagnosis and management of numerous medical conditions, including neoplasms, abnormal cytological findings, and polyps. The code is widely utilized in laboratory settings, where pathologists analyze samples to provide essential clinical insights.
Major payers covering CPT code 88304 include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication offers a comprehensive overview of payer coverage, policy updates, and clinical benchmarks relevant to this code. Readers will gain insight into the clinical context of surgical pathology, typical sites of service, and the importance of accurate coding for laboratory-based procedures.
Key topics addressed include the role of CPT code 88304 in anatomic and clinical pathology, common diagnoses associated with its use, and related codes such as CPT code 88305. The summary also highlights the use of modifiers for professional and technical components, as well as the taxonomies linked to pathology services. This resource is designed to inform healthcare professionals, billing specialists, and policy analysts about current trends and requirements for surgical pathology billing and reimbursement.
CPT Code Overview
CPT code 88304 represents a Level III surgical pathology service involving both gross and microscopic examination of tissue specimens. This procedure is a core component of anatomic pathology, providing critical diagnostic information for a wide range of clinical scenarios. The typical site of service for CPT code 88304 is a laboratory setting, specifically designated as Place of Service 81. Surgical pathology services like this are essential for guiding patient management and treatment decisions across various healthcare settings.
Clinical & Coding Specifications
Clinical Context
A patient presents with a suspicious skin lesion, breast lump, colon polyp, or abnormal cervical cytology. The clinician performs a biopsy or excision of the tissue. The specimen is sent to the laboratory (Place of Service 81) for evaluation. A pathologist performs a Level III surgical pathology service, which includes both gross and microscopic examination of the specimen. The results inform diagnosis and guide further management.
Coding Specifications
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Modifier
26: Used when reporting only the professional component of the pathology service (interpretation by the pathologist). -
Modifier
TC: Used when reporting only the technical component (preparation and processing of the specimen in the laboratory).
| Taxonomy Code | Specialty Name |
|---|---|
207ZP0102X | Anatomic Pathology |
207ZP0101X | Clinical Pathology |
207ZP0007X | Pathology |
- These taxonomies represent providers specializing in pathology, including both anatomic and clinical subspecialties.
Related Diagnoses
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C44.99: Other specified malignant neoplasm of skin- Relevant for pathology examination of skin lesions suspected to be malignant.
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D49.2: Neoplasm of unspecified behavior of bone, soft tissue, and skin- Used when the behavior of a neoplasm is unclear, requiring pathology review.
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N63: Unspecified lump in breast- Indicates a breast lump, often requiring biopsy and pathology evaluation.
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K63.5: Polyp of colon- Colon polyps are commonly excised and sent for pathology to determine their nature.
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R87.619: Unspecified abnormal cytological findings in specimens from cervix uteri- Used for abnormal cervical cytology specimens needing further pathology assessment.
Related CPT Codes
88305: Level IV — surgical pathology, gross and microscopic examination (for skin other than cysts, tags, debridement and plastic repair)
88305 is used for more complex specimens than those covered by 88304, such as skin biopsies excluding cysts, tags, debridement, and plastic repair. In clinical workflow, 88304 and 88305 may be used as alternatives depending on the specimen type. They are not typically billed together for the same specimen.