Pathology/Lab Coding Alert

You Be the Coder, "Don't Sell Yourself short on Margin Exam" (Pathology/Lab Coding Alert, Vol. 10, No. 9), asked how to code a lumpectomy with separately submitted margins.

The answer advised: "Because the pathologist grossly determines that the lumpectomy margins are not clear, he might not perform (and note in the pathology report) microscopic margin evaluation. If that is the case, you should code the lumpectomy as 88305 (Level IV -- Surgical pathology, gross and microscopic examination, breast, biopsy, not requiring microscopic evaluation of surgical margins)."

Correct coding: You should code the lumpectomy as 88307 (Level V -- Surgical pathology, gross and microscopic examination, breast, mastectomy -- partial/simple).

Why: Code 88307 includes two breast specimens: the partial mastectomy listed above, and "Breast, excision of lesion, requiring microscopic evaluation of surgical margins." Although lumpectomy usually involves margin evaluation, the margin exam is not a "condition" for the partial mastectomy specimen as it is for the lesion excision specimen. You should always code a partial mastectomy as 88307.

Lumpectomy confusion: Some sources have equated lumpectomy to lesion excision (June 2003 CAP Today). However, the American Medical Association considers the specimen to be a partial mastectomy, as shown in the surgical code 19301 (Mastectomy, partial [e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy).

Special thanks to Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc., publisher of the Pathology Service Coding Handbook, in The Villages, Fla. for pointing out this error.