The Current Procedural Terminology (CPT) codes form the standardized language used to describe medical services and procedures for billing and insurance claims within the United States. These five-digit codes allow healthcare providers and payers to communicate precisely about the care a patient receives. CPT 88305 represents a specific service in surgical pathology: the examination of tissue removed from a patient to diagnose disease. This code indicates that a tissue specimen has undergone a specific level of analysis by a pathologist and laboratory staff.
Decoding CPT 88305
The full description of CPT 88305 is “Surgical Pathology, Gross and Microscopic Examination, Level IV.” Surgical pathology is the process of examining tissue specimens, such as biopsies or resections, removed during a procedure. The goal of this examination is to determine the presence, cause, or extent of a disease, such as cancer or inflammation.
The term “Gross and Microscopic Examination” involves two distinct stages of analysis. The gross examination is the visual inspection of the tissue by a pathologist before processing, where they measure and describe its physical characteristics. The microscopic examination is the second, more detailed stage where the pathologist reviews thin slices of the tissue under a microscope to make a final diagnosis.
The “Level IV” designation identifies the complexity of the service and the types of specimens it covers. Level IV specimens require a moderate amount of preparation and specialized pathologist time for analysis. They are generally considered common and represent a standard level of complexity, which helps standardize the time and resources required to process and interpret the tissue sample.
Common Tissues Examined Under Level IV
A broad range of common tissue samples fall under the CPT 88305 classification due to their similar requirements for standardized preparation and analysis time. These specimens typically represent standard, non-complex diagnoses that still require detailed gross and microscopic evaluation by the pathologist.
Examples of specimens frequently coded as Level IV include routine skin excisions for moles or other lesions, and standard prostate needle biopsies. Biopsies of the gastrointestinal tract, such as polyps removed during a colonoscopy or stomach biopsies, are also commonly classified under this code.
Standard breast core biopsies or excisional biopsies for a lump, along with tissue from the cervix or endometrium, are other frequent uses of CPT 88305. The Level IV code is assigned because these samples require a standardized, detailed histopathology analysis to rule out or confirm conditions like cancer, infections, or inflammatory disorders. A single distinct tissue sample from a specific site is considered one specimen for billing purposes, even if multiple microscopic slides are created.
The Journey of the Specimen in the Lab
The process a tissue specimen undergoes in the laboratory is a multi-step procedure that ensures an accurate diagnosis. Once removed from the patient, the specimen is placed into a preservative, typically formalin, which fixes the tissue to prevent decay and preserve cellular structures. The first step in the lab is accessioning, where the specimen is formally received, given a unique identifying number, and matched with the patient’s information.
The pathologist then performs the gross examination, visually inspecting the tissue, measuring its dimensions, and describing any visible abnormalities like tumors or ulcers. This crucial step determines which parts of the tissue will be sampled for microscopic slides. Selected portions are then placed into small cassettes and undergo tissue processing, where the water in the cells is replaced with paraffin wax.
This wax embedding creates a firm block, allowing the lab technician to cut the tissue into incredibly thin sections using an instrument called a microtome. These thin sections are then placed onto glass slides and stained with dyes, most commonly Hematoxylin and Eosin (H&E), which make the cellular and tissue components visible under the microscope.
The microscopic examination is where the pathologist reviews the stained slides to look for cellular changes, inflammation, or structural abnormalities that indicate disease. The pathologist’s interpretation of these microscopic findings, combined with the gross description, culminates in a final pathology report. This report communicates the definitive diagnosis back to the treating physician, guiding the patient’s treatment plan.
How CPT 88305 Appears on a Medical Bill
When a patient receives a medical bill containing CPT 88305, it represents the charge for the entire pathology service performed on their tissue specimen. This charge frequently appears as a separate bill from a pathology group, distinct from the surgeon’s or hospital’s fees, because the service is often performed by an independent laboratory.
The total charge for CPT 88305 is often split into two parts: the technical component and the professional component.
Technical Component
The technical component covers the laboratory’s work, including tissue processing, creating the paraffin block, cutting the slides, and staining the sections.
Professional Component
The professional component covers the pathologist’s intellectual work, which includes the gross examination, microscopic interpretation of the slides, and generating the final diagnostic report.
Insurance coverage for CPT 88305 is common, provided the service is deemed medically necessary to diagnose or rule out a suspected condition. Patients may still be responsible for a portion of the cost, such as a co-pay, deductible, or co-insurance, depending on their specific health plan. If there are questions about the charge or financial responsibility, the most direct approach is to contact the billing department of the pathology group listed on the statement.