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Billing G0416

Pam Posted Tue 06th of January, 2015 17:18:00 PM

Can we bill HCPCS code G0416 twice if our pathology department receives two separate containers, one labeled as "prostate biopsies from the LEFT side" and one labeled as "prostate biopsies from the RIGHT side"?

SuperCoder Answered Tue 06th of January, 2015 19:24:37 PM

Thanks for your question. In this scenario you would only report G0416; surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method, any number of specimens once. In the past, you were instructed to select from a different code set when the provider biopsied less than 10 specimens. For 2015, you will bill one unit of G0416 for any number of prostate needle core specimens for Medicare beneficiaries (consult your Tricare and Medicaid agencies to see if they also require G0416). See the following link for additional information on G0416 billing.

https://www.supercoder.com/coding-newsletters/my-pathology-lab-coding-alert/physician-fee-schedule-2015-revamp-prostate-biopsy-coding-again-144225-article

Pam Posted Fri 09th of January, 2015 12:39:37 PM

So just to clarify.....even if the specimens are submitted in separate containers and one is labeled "left" and one is labeled "right" we still cannot be bill G0416(x2), correct?

SuperCoder Answered Fri 09th of January, 2015 13:28:46 PM

That is correct, this code description and the fee schedule has been revised to account for multiple specimens without having to bill multiple units.

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