Pathology/Lab Coding Alert

Coding for pathology consultation during surgery can be a source of confusion for many. A proper understanding of the work described by each of the pathology codes 88329-88332 is imperative for proper reimbursement. Coders must also know what services are not included because these may be reported separately.

As with any consultation, the family of pathology codes 88329-88332 involves a request for service, the rendering of a medical judgment, and a report. But the specific nature of these codes is that the pathologist is providing immediate feedback to the surgeon during the procedure, reports R.M. Stainton Jr., MD, president of Doctors Anatomic Pathology Services, an independent pathology laboratory in Jonesboro, Ark. In this way, the information supplied by the pathologist can guide the surgeons decisions regarding course of the surgery.

The pathologists consultation immediately may confirm a neoplasm for resection, identify metastases, or indicate whether the margins of a resection are clear. The pathology consultation during surgery can also let the surgeon know if an adequate specimen has been obtained for diagnosis, says Stainton.

Explanation of Codes for Pathology During Surgery

1. Code 88329: Code 88329 (pathology consultation during surgery) represents gross examination only, reports Elizabeth Sheppard, HT (ASCP), manager of anatomic pathology at Wake Forest University Baptist Medical Center in Winston Salem, N.C. We use this code most often when a pathologist is asked for a quick look at a specimen or a margin during surgery, without giving a definitive analysis.

Stainton adds, We use 88329 to describe the gross examination of margins for a bowel resection. This specimen typically includes an obvious lesion, and several centimeters of normal mucosa before the margins, so a gross examination is all that is required. We also use 88329 to document a foreign body.

2. Code 88331: Use 88331 (pathology consultation during surgery; with frozen section[s], single specimen) to report the pathologists evaluation during surgery of any number of frozen sections from a tissue block. A block is a portion of tissue that has been prepared for sectioning, in this case by freezing. Frozen sections are thin slices cut from the block. Evaluating frozen sections from a tissue block often is used for rapid microscopic diagnosis.

3. Code 88332: Use CPT 88332 (pathology consultation during surgery; each additional tissue block with frozen section[s]) to report the pathologists evaluation during surgery of any number of frozen sections from a second or subsequent tissue block from the same specimen.

Report 88331 and 88332 for frozen sections of the same specimen, taken from different tissue blocks, [...]