Pathology/Lab Coding Alert

Distinguish meninges from spinal cord.

If your pathologists work downstream from a neurosurgery practice, you need to know a thing or two about identifying specimens and diagnoses for various spinal cord-related tissues your practice might encounter.

Some spinal cord specimen names you might see in a pathology note may be “unlisted” in the CPT^® anatomic pathology exam codes 88302-88309. Coupled with the need to distinguish spinal tumor types and sites for assigning the correct diagnosis code, you have a lot to master if you want to code these cases correctly. Read on to let our experts guide you through some spinal-nerve coding basics.

Learn Terms and Codes for Spinal Column Specimen Exams

Aside from bone specimens, your pathologist might examine a wide range of tissues from a spinal column surgery, which you can find listed as a CPT^® pathology specimen under the following codes:

• 88302, Level II - Surgical pathology, gross and microscopic examination …Nerve …Sympathetic ganglion
• 88305, Level IV - Surgical pathology, gross and microscopic examination …Brain/meninges, other than for tumor resection…Nerve, biopsy …
• 88307, Level V - Surgical pathology, gross and microscopic examination …Brain/meninges, tumor resection …

Use Similar Specimens to Guide Code Choice

“Sometimes we receive specimens that you don’t see in the list, such as ‘spinal cord biopsy,” explains R.M. Stainton Jr., MD, president of Doctors Anatomic Pathology Services in Jonesboro, Ark.

Recall: CPT^® organizes surgical pathology specimen examination into six codes with ascending levels of difficulty and required resources. If you find the specimen listed under a code, you need to report that code. But if your pathologist examines a specimen that is not listed, you should assign the specimen “to the code which most closely reflects the physician work involved when compared to other specimens assigned to that code.”

If you need to assign an unlisted spinal column specimen, it’s helpful to notice what the listed nerve specimens entail.

The 88302 service describes an exam to identify and report that the tissue is a nerve or sympathetic ganglion. The 88305 service describes a nerve biopsy or exam of meninges “other than for tumor,” while 88307 describes a meninges tumor resection.

If you encounter an unlisted spinal column specimen in a pathology report, you can think about how the tissue is synonymous or similar to one of the above listed specimens and assign the code accordingly.

For instance: Assign 88305 if your pathology report describes any of the following unlisted specimens:

• Neuroma, non-traumatic (such as neurofibroma)
• Spinal cord biopsy — because the spinal cord is a nerve, this is equivalent to nerve biopsy
• The following three terms describe layers of the meninges, so you should consider them equivalent to a meninges specimen, other than for tumor.

             o Arachnoid mater, other than for tumor
             o Dura mater, other than for tumor
             o Pia mater, other than for tumor

If the pathology report describes excised tumor tissue associated with the spinal cord, such as any of the following terms, you should assign 88307, which is equivalent to listed specimen meninges tumor resection:

• Nerve tumor (such as schwannoma)
• Arachnoid mater tumor
• Dura mater tumor
• Pia mater tumor
• Spinal meningioma
• Spinal cord tumor

Use 88307 whether the tumor is malignant or benign. “Malignant tumors of the spinal cord are typically glioblastoma. Metastatic neoplasms can also be rarely seen,” says Gregory Przybylski, MD, New Jersey Neuroscience Institute, JFK Medical Center, Edison. “Fortunately, most spinal cord neoplasms are benign, including astrocytoma and ependymoma.”

Other possibilities: Remember that if you see a specimen not listed in CPT^® or given as an example here, you should start by searching for synonyms in the CPT^® list. For instance an “epidural hematoma” or “meningematoma” would take the same code as “hematoma,” which CPT^® lists as an 88304

specimen (Level III - Surgical pathology, gross and microscopic examination … Hematoma …).

If you can’t find a synonym in the code list, consult with your pathologist to ensure you assign the unlisted specimen to a surgical pathology exam level commiserate with the work involved.

Find ICD-10 Code Choices

Some of the common diagnosis codes you should be familiar with for spinal-cord-associated specimens distinguish site, and benign or malignant tumors, such as the following:

• D32.1, Benign neoplasm of spinal meninges
• D33.4, Benign neoplasm of spinal cord
• D36.1, Benign neoplasm of peripheral nerves and autonomic nervous system (such as sympathetic ganglion)
• C47.9, Malignant neoplasm of peripheral nerves and autonomic nervous system, unspecified
• C70.1, Malignant neoplasm of spinal meninges
• C72.0, Malignant neoplasm of spinal cord