Pathology/Lab Coding Alert

Codes distinguish biopsy, conization -- make sure you know the difference

You receive cervical tissue that a surgeon removed using the loop electrocautery excisional procedure (LEEP). What's the pathology specimen -- biopsy (88305) or conization (88307)? With a payment difference of $81.10, you-ll want to be sure to choose the right code.

Distinguish Surgical Pathology Levels 

The pathology exam of a LEEP specimen might fall under one of these codes:

- 88305 -- Level IV - Surgical pathology, gross and microscopic examination, cervix, biopsy

- 88305 -- Level IV - Surgical pathology, gross and microscopic examination, endocervix, curettings/biopsy

- 88307 -- Level V - Surgical pathology, gross and microscopic examination, cervix, conization.

But how do you know which code to use?

Good idea: -If the surgical note does not clarify the intended specimen, the pathologist must determine the level of work involved in the tissue exam and document the specimen as a cone or a conventional biopsy and code accordingly,- says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc., a pathology business practices publishing company in Simpsonville, Ky.

Tip: If the surgeon submits two or three separate cervical LEEP tissue excisions without identifying the specimen type, you should code each individually according to the work required -- either conventional biopsy or conization. -Don't bundle the specimens into a single 88307 as though you-d received a single conization,- Padget says. -It's proper to separately report each specimen, although the physician work might be akin to 88305, 88307 or one of each.-

Better: If the surgical note identifies the LEEP specimen as a conventional biopsy or conization, you should use the surgeon's designation.

Take a Hint From the Surgical Procedure

Because LEEP surgical codes distinguish between conizations and biopsies, you can use the surgical procedure to help decipher the surgeon's intended specimen.

Conization codes:

- 57522 (Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; loop electrode excision) describes a LEEP conization procedure without using a colposcope that results in a cervical cone specimen.

- 57461 (Colposcopy of the cervix including upper/adjacent vagina; with loop electrode conization of the cervix) describes a LEEP conization of the cervix using a colposcope, also resulting in a cervical cone specimen.

Biopsy codes:

- 57460 (Colposcopy of the cervix including upper/adjacent vagina; with loop electrode biopsy[s] of the cervix) describes a LEEP cervical biopsy with the use of a colposcope. Pointer: If the surgeon submits multiple, separately identified biopsies, the pathologist should code each as 88305.

- 57500 (Biopsy, single or multiple, or local excision of lesion, with or without fulguration [separate procedure]). Although this code does not specify LEEP, the surgeon would use this code for a LEEP biopsy without a colposcope. Again, the pathologist should report multiple units of 88305 for multiple, separately identified biopsies even if the surgeon only reports one unit of 57500.

Caution: Regardless of the surgical code, if the surgeon submits the LEEP tissue as multiple, separate specimens, you should code each according to the work involved.