Your CPT Questions

June 2005

Q: When we have a Whipple specimen, is it appropriate to charge separately for the stomach or duodenum, or both, or are both specimens included in the CPT code 88309 charge?

A. The Whipple procedure may include resection of multiple distinct parts-pancreatic head, distal stomach, duodenum, distal biliary tree, and gall bladder. None may be billed separately. A Whipple resection is reported as a single unit of 88309, Level VI-surgical pathology, gross and microscopic examination, pancreas, total/subtotal resection.

Q: I received a request to interpret a coagulation mixing study for a hospital inpatient with a prolonged partial thromboplastin time. The mixing study with normal plasma corrected the PTT. I wrote a report for the patient's medical record concluding that the correction of the prolonged PTT implies a factor shortage or deficiency rather than an inhibitor. Is there a CPT code I can use to bill for my professional service?

A. It is appropriate to bill for your services using CPT code 85390-26, Fibrinolysins or coagulopathy screen, interpretation and report, which covers physician interpretation and reporting of coagulation testing. Since the service was provided by a laboratory physician, the modifier 26 must be appended to the CPT code to indicate the professional component. Furthermore, because this service was provided as an inpatient service, it will be paid under the Medicare Part B physician fee schedule.

Frequently asked questions about CPT are published bimonthly in “Capitol Scan.” This section of CAP TODAY is a product of the CAP Economic Affairs Committee.

The codes and descriptions listed here are from Current Procedural Terminology, 4th ed., CPT 2006. CPT 2006 is copyrighted by the American Medical Association. To purchase CPT books, call the AMA at 800-621-8335.

For more information about CPT coding, visit the CPT Coding Resource Center on the CAP Web site.