Tim Webster at Northwestern Medical Center inSt Albans, Vermont asks:

>>...I wanted to ask people how they deal with CPT codes, specifically, 
disparities between tissues that have the same charge but involve dissimilar 
effort. - For example: Simple vs complex skins. (Complex defined for now as 
an ellipse

tagged with a suture for orientation, requiring multiple colored inks for

the margins, and more blocks than a straightforward "simple" skin.) Both

charge 88305, yet one is much more work than the other. (Similarly, how come

a 0.2x0.2x0.2cm GI biopsy also charges 88305?) - How do you handle charges 
like this, and is there a way within the guidelines for "adjustments"? I know 
our noble Samurai Pathologist, Bob Richmond has commented on charges before, 
but only to the limit of whose ultimately responsible - namely the 
pathologist I/C! <<

First of all, as I said before, the pathologist has the responsibility, and 
should be very careful in delegating the CPT coding.

Second, life - and CPT - isn't fair. For the pathologist, a seborrheic 
keratosis that can be diagnosed in a couple of seconds under low power gets 
the same code as a difficult melanoma that ultimately has to go to a 
consultant.

Some "adjustments" are possible, but Medicare - and most insurors - usually 
don't pay them. They take an expert coder to do.

Bob Richmond
Samurai Pathologist
Knoxville TN