Pathology/Lab Coding Alert

3 scenarios show the way to accurate pay.

You use the same procedure code for a uterine fibroid or polyp specimen, so how could getting the diagnosis wrong cost your pathologist pay?

Let our experts unravel the mystery with a primer for diagnosis and procedure codes, plus three examples to showcase appropriate billing opportunities.

Zero-In On Diagnosis Codes

"Uterine fibroids and polyps are similar because they're both growths, but they're from different source tissue, and ICD-9 categorizes them to completely different codes," says Melanie Witt, RN, COBGC, MA, an independent coding consultant in Guadalupita, N.M.

Uterine Polyps: An overgrowth of the endometrial lining, polyps usually occur within the uterine cavity and are typically malleable and small. Uterine polyps are often superficial, and therefore easy to remove.

ICD-9 distinguishes uterine polyps based on location and pathology, as follows:

• 621.0 -- Polyp of corpus uteri. The pathology report might list this finding as an endometrial polyp or a uterine polyp. This code refers only to intracavitary polyps: it excludes polyps removed from the cervix. You should report cervical polyps with the following code:
• 622.7 -- Mucous polyp of cervix. This code includes any cervical polyp not otherwise specified, but excludes adenomatous cervical polyps. You should report this neoplastic cervical polyp with the following code:
• 219.0 -- Other benign neoplasm of cervix uteri. Use for adenomatous cervical polyps.

Uterine Fibroids: Fibroids are outgrowths of the smooth muscle of the uterine wall, and they may be much larger, tough, and "embedded" in the thick muscular layer of the uterus. You might also see fibroid called "leiomyoma," "myoma," "fibromyoma," or "leiomyofibroma."

"ICD-9 distinguishes fibroids based on the location within the uterine wall," Witt says.

• 218.0 -- Submucous leiomyoma of uterus. These grow from the uterine wall toward the uterine cavity, and are sometimes called intracavitary fibroids.
• 218.1 -- Intramural leiomyoma of uterus. These grow within the uterine wall (myometrium) and are sometimes called interstitial fibroids.
• 218.2 -- Subserous leiomyoma of uterus. These grow outward from the uterine wall toward the abdominal cavity, and are sometimes called subperitoneal fibroids.
• 218.9 -- Leiomyoma of uterus unspecified.

Grasp Procedure Code Differences

Although you can see that ICD-9 provides many codes to distinguish uterine fibroids and polyps, CPT provides just two codes to describe the pathologist's exam of these specimens. The code distinction depends on whether the surgical specimen is the entire uterus (with fibroids) or just the excised fibroid or polyp.

Look at the following code definitions to see how you would report these services:

• 88305 -- Level IV - Surgical pathology, gross and microscopic examination, Leiomyoma(s), uterine myomectomy - without uterus
• 88305 -- ... Polyp, cervical/endometrial The Medicare Physician Fee Schedule (MPFS) global national payment amount for 88305 is $105.86 (conversion factor 34.0376)
• 88307 -- Level V - Surgical pathology, gross and microscopic examination, Uterus, with or without tubes and ovaries, other than neoplastic/prolapseThe MPFS global national payment amount for 88307 is $234.52 (conversion factor 34.0376).

Don't miss neoplasm quirk: Even though ICD-9 classifies uterine fibroids as benign neoplasms, you shouldn't use the CPT uterine neoplasm code to report your pathologist's work (88309, Level VI -- Surgical pathology, gross and microscopic examination; Uterus, with or without tubes and ovaries, neoplastic). The AMA and College of American Pathologists (CAP) have both published coding instruction that points coders to 88307 for a uterus specimen with leiomyoma, because the specimen requires less work.

Scenarios Show You What To Do

Now that you know the basics of ICD-9 and CPT coding for uterine polyps and fibroids, let the following examples guide your specimen reporting.

Scenario 1: The pathologist receives a container with two "intracavitary uterine fibroids," according to the surgical report. The pathologist confirms the diagnosis of uterine leiomyoma for each fibroid.

Solution 1: Code the case as 88305 (...Leiomyoma(s), uterine myomectomy - without uterus) and 218.0. "Even though the pathologist diagnoses two fibroids, you should report only one unit of 88305 because the surgeon did not individually identify the fibroids," says R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark. The pathologist's pay is $105.86 (per above pricing).

Scenario 2: The pathologist receives a container with two "intracavitary uterine fibroids," according to the surgical report. In this case, the pathologist diagnoses one "submucous leiomyoma of uterus," and one "endometrial polyp."

Solution 2: The correct coding for this case is as follows:

• 88305 (...Leiomyoma(s), uterine myomectomy - without uterus) and 218.0.
• 88305 (...Polyp, cervical/endometrial) and 621.0.

The pathologist's pay for this case is $211.72 (per above pricing for 88305 x 2), versus $105.86 if you missed the polyp diagnosis.

Scenario 3: The pathologist receives a hysterectomy specimen with multiple myomas. He diagnoses an intramural and two subserous fibroid tumors.

Solution 3: Code the case as 88307 and 218.1, 218.2. "You shouldn't bill three units of 88305 for the individual fibroids, because the specimen is the uterus, which earns 88307 for leiomyomas," Stainton says. The pathologist earns $234.52 for the 88307 charge in this case, versus $317.58 for wrongly coding88305 x 3 (per above pricing).

Bottom line: Coding leiomyoma and polyp cases wrong could cost you pay, or leave you owing money that you overcharged.