Is D0485 used for initial biopsy evaluations?

No, D0485 is specifically for consultative evaluations, not initial biopsy assessments.

Can D0485 be billed multiple times for the same patient?

It depends on the clinical necessity and insurance policies. Always check for frequency limitations.

Does D0485 require prior authorization?

This can vary by insurance provider, so it's important to verify with the specific plan.

What documentation is needed for D0485?

You need a referral, clinical notes, biopsy details, and the pathologist's report for proper billing.

D0485

Consultation with Biopsy Slide Prep - CDT Code Guide

Diagnostic/Oral Pathology Laboratory

Overview

CDT code D0485 pertains to a specialized diagnostic service where a consulting pathologist prepares slides from biopsy material provided by a referring source. This procedure is crucial in complex cases requiring a detailed pathological evaluation to aid in diagnosis or to provide a second opinion at the patient's request. The pathologist not only prepares the slides but also delivers a comprehensive written report, which is integral for accurate diagnosis and treatment planning. This service is typically employed in cases where initial diagnosis is inconclusive or when a specialized opinion is necessary to determine the appropriate course of action.

When to Use This Code

When a biopsy sample requires expert pathological evaluation.
In cases where initial diagnostic results are inconclusive.
When a second opinion is requested by the patient or referring dentist.
For complex oral pathology cases needing specialized consultation.
When preparing for a treatment plan that requires detailed pathological insights.

Documentation Requirements

Detailed referral from the primary dentist or specialist.
Comprehensive clinical notes justifying the need for consultation.
Clear documentation of the biopsy material provided.
Written report from the consulting pathologist.
Patient consent for the consultation and slide preparation.
Accurate coding and billing information including the D0485 code.

Billing Considerations

When billing for D0485, ensure that the service is justified by the clinical notes and referral documentation. Frequency limitations may apply, and it's important to check with the patient's insurance provider for coverage specifics. Common modifiers may include those indicating a second opinion or consultation service. Always verify if prior authorization is required by the insurance plan.

Related CDT Codes

D0470 D0502 D0417 D0460 D0504

Frequently Asked Questions

D0485 covers the preparation of slides from biopsy material and the provision of a written report by a consulting pathologist.

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