Pathology/Lab Coding Alert

Question: My pathologist states that the work for a ligament specimen exam is equivalent to a soft tissue specimen. Is it acceptable to code the ligament specimen as 88305 instead of 88304?

Answer: The answer is a conditional yes. Because "ligament" is an unlisted specimen, you should code the service based on the physician work involved compared to similar specimens, according to CPT instruction. If your pathologist says the work is similar to a soft tissue specimen, the appropriate code would be 88305 (Level IV -- Surgical pathology, gross and microscopic examination, soft tissue, other than tumor/mass/lipoma/debridement).

That said, you should be cautious about reporting 88305 for a ligament specimen. Your question indicates that you're aware of the general standard that a ligament is equivalent, for average physician work, to listed specimens under 88304, specifically, tendon. A more conventional coding for a ligament specimen would be 88304 (Level III -- Surgical pathology, gross and microscopic examination, ...), which lists specimens such as "tendon/tendon sheath". If your pathologist routinely lists ligament as 88305, you may have trouble justifying the position in an audit. But if your question deals with a specific ligament specimen that your pathologist finds more difficult and thus equivalent to soft tissue, you could report 88305 with appropriate documentation that shows work equivalent to an 88305 specimen.

Slippery slope: Equating unlisted specimens to soft tissue can lead to code inflation -- for example, if your pathologist equated a tendon to a soft tissue biopsy. CPT lists soft tissue under three other codes in addition to 88305:

• 88304 -- Soft tissue, debridement; Soft tissue, lipoma
• 88307 -- Level V -- Surgical pathology, gross and microscopic examination, soft tissue mass (except lipoma), - biopsy/simple excision
• 88309 -- Level VI -- Surgical pathology, gross and microscopic examination, soft tissue tumor, extensive resection.

Bottom line: Code 88304 is a better choice for ligament specimens.