Advanced Search

Pathology/Lab Coding Alert

Know the 5-7-9s of Breast Coding

Published on Thu May 01, 2003

With multiple breast codes and many tissue descriptions, what's a coder to do? You can simplify surgical pathology coding for breast tissue if you answer four key questions about the specimen:

1. What is the tissue?

2. Does the specimen require surgical margin examination?

3. What was the reason for the breast tissue removal?

4. Are lymph nodes submitted with the specimen, and are they contiguous or separate?

"Taken separately, none of these questions will determine the correct code, but answered together, you can decide which of the surgical pathology breast codes to report," says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha.

88305 Lists Two Breast Specimens

CPT lists two distinct breast tissue specimens under surgical pathology code 88305:

  • 88305 Level IV Surgical pathology, gross and microscopic examination, breast, biopsy, not requiring microscopic evaluation of surgical margins.

    Report this code for a routine biopsy. The specimen may be acquired by various methods such as core needle biopsy, incisional biopsy, stereotactic core biopsy or ultrasound-directed core-biopsy. Regardless of the method, you can answer the four key questions for this specimen as follows:

    1. The tissue is a portion of a breast lesion.

    2. The specimen does not require microscopic evaluation of surgical margins. "Do not use this code when the pathologist receives the entire lesion, no matter how small, and must evaluate margins, even if the surgical report uses the term 'biopsy' (e.g., excisional biopsy)," Slagle says.

    3. The reason for the test is to sample a lesion for diagnostic purposes, usually following the discovery of a breast lump or mass, Slagle says.

    4. Surgeons generally do not submit lymph nodes with breast biopsy tissue.

  • 88305 Breast, reduction mammoplasty.

    Also report 88305 for the pathologist's gross and microscopic exam of breast tissue removed for reduction mammoplasty. "Following this surgical procedure, the pathologist almost always receives two separate specimens from the left and right breasts. Report the entire service as 88305 x 2," Slagle says. The key features that indicate this service are as follows:

    1. The specimen is normal breast tissue.

    2. The pathologist confirms healthy tissue. "Do not use this code if the physician finds unexpected pathology that requires margin examination," Slagle says.

    3. The reason for the breast tissue removal is reduction mammoplasty.

    4. You would not expect to find lymph nodes submitted with reduction mammoplasty specimens.

    Margins and More Distinguish Two CPT 88307 Breast Specimens

    "As with 88305, CPT lists two distinct breast tissue specimens under surgical pathology code 88307," says R.M. Stainton Jr., MD, president of Doctor's Anatomic Pathology, an independent pathology laboratory in Jonesboro, Ark.

  • 88307 Level V Surgical pathology, gross and microscopic examination, breast, excision of lesion, requiring microscopic evaluation of surgical margins.

    "Report this code when the surgeon attempts to remove the entire breast lesion," Stainton says. This may occur following a biopsy and confirmed diagnosis of neoplasm. The surgeon may call the specimen a lumpectomy.

    1. The specimen is the lesion, including margins.

    2. The pathologist performs microscopic evaluation of surgical margins.

    3. The reason for the test is to remove a breast lesion for diagnostic and/or treatment purposes.

    4. The surgeon may submit a separately identified lymph node with a lesion excision. "Don't let those fool you they are not part of the lumpectomy specimen and don't change the breast tissue code," Stainton says. Instead, a separate lymph node represents a separate specimen, and you should report it as an additional 88305 ( lymph node, biopsy).

  • 88307 breast, mastectomy partial/simple.

    Report this code when the pathologist examines some type of partial breast removal, typically for the treatment of cancer. The surgeon may also call the specimen a quadrantectomy.

    1. The specimen is the entire or partial breast encompassing the identified pathology.

    2. The pathologist usually evaluates margins, although it is not necessary for this code.

    3. The surgeon typically performs the procedure to remove previously diagnosed breast cancer, although other disease may be the cause.

    4. "If the surgeon submits the entire breast and includes contiguous lymph nodes, do not report this code it is no longer a simple mastectomy," Stainton explains. Separately report noncontiguous lymph node(s) submitted with a partial mastectomy.

    88309 Is Radical Mastectomy

    When the surgeon submits the entire breast with contiguous lymph nodes, report 88309 (Level VI Surgical pathology, gross and microscopic examination, breast, mastectomy with regional lymph nodes). "This is the only breast specimen that includes bundled lymph nodes," Stainton says.

    1. The specimen is the entire breast including regional lymph nodes.

    2. The pathologist evaluates margins.

    3. The surgeon performs the radical mastectomy for cancer treatment.

    4. This specimen includes associated lymph nodes, so do not report these separately.

     

    • Other Articles in this issue of

    Pathology/Lab Coding Alert

    View All