Pathology/Lab Coding Alert

Question: If the pathologist receives a specimen labeled “breast excisional biopsy” or “needle localization biopsy” and diagnoses “fibrocystic change,” should we bill 88305 or 88307? The pathologist states that a margin exam is not required for this diagnosis.

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Answer: You should report a breast biopsy as 88305 (Level IV - Surgical pathology, gross and microscopic examination…, Breast, biopsy, not requiring microscopic evaluation of surgical margins…). As your pathologist stated and as the code states, a margin exam is not required for a breast biopsy specimen, regardless of the diagnosis.

On the other hand, if the pathologist examines a breast lesion excision that requires margin exam, you should bill 88307 (Level V - Surgical pathology, gross and microscopic examination… Breast, excision of lesion, requiring microscopic evaluation of surgical margins…). Be aware that an “excisional” biopsy is still a biopsy, and does not require a margin exam. 

Other 88307: You’ll notice that CPT® lists another breast specimen under 88307 — … Breast, mastectomy - partial/simple. Although the pathologist would typically perform a margin exam as part of a partial/simple mastectomy evaluation, the code definition doesn’t specify margin exam, and the pathologist’s statement of margin exam is not required to justify 88307 if the specimen is clearly identified as a partial or simple mastectomy. Other terms that fit the partial/simple mastectomy definition include lumpectomy, tylectomy, quadrantectomy, or segmentectomy.