CPT Code 88305: Results of Progressive Corrective Action (PCA)

CGS conducted probe reviews on providers that submitted claims for CPT code 88305 Level IV-Surgical pathology and microscopic examination; providers were selected for these reviews based on their allowed services and charges. The overall error rate for Kentucky exceeded 21%, and the overall Ohio error rate exceeded 56.39%.

Based on the review of 200 claims, CGS identified the following issues.

• The documentation did not support CPT code 88305 (a different surgical pathology code should have been submitted based on these records)
• No documentation was present to support the order/intent to order

MAC J15 for Kentucky and Ohio