Pathology/Lab Coding Alert

You can usually separately charge for lymph nodes with these specimens.

Coders often wonder whether certain specimens routinely involve associated lymph nodes. Study the following list for common surgical pathology specimens that don't ordinarily have lymph nodes attached:

• Cystectomy (88309, ... urinary bladder, partial/total resection)
• Esophagectomy (88309, ...esophagus, partial/total resection)
• Gastrectomy (88307, ... Stomach, subtotal/total resection, other than for tumor or 88309, Stomach, subtotal/total resection for tumor)
• Hysterectomy (88307, ...uterus, with or without tubes and ovaries, other than neoplastic/prolapse or 88309, uterus, with or without tubes and ovaries, neoplastic)
• Nephrectomy (88307, ... kidney, partial/total nephrectomy)
• Oophorectomy (88305, ... ovary with or without tube, non-neoplastic or 88307, ... ovary with or without tube, neoplastic)
• Prostatectomy (88307, ... prostate, except radical resection or 88309, ... prostate, radical resection)
• Skin (88305, ...skin, other than cyst/tag/debridement/ plastic repair)
• Soft tissue mass (88307, ...soft tissue mass (except lipoma), biopsy/simple excision or 88309, ...soft tissue tumor, extensive resection)
• Thyroidectomy (88307, ... thyroid, total/lobe)

Opportunity: "In most cases, you can separately code for lymph nodes received with one of the preceding specimens," says R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark.

Except for incidental node(s), you should charge for the additional lymph node specimen(s) using one of the following codes:

• 88305 -- Level IV -- Surgical pathology, gross and microscopic examination, lymph node, biopsy
• 88307 -- Level V -- Surgical pathology, gross and microscopic examination, lymph nodes, regional resection
• 88307 -- ... sentinel lymph node.