Pathology/Lab Coding Alert

Question: The pathologist dictates, "Lymph node segregated from breast tissue for extensive macroscopic exam and dissection using sterile technique. ... The node is bisected, revealing a suspicious area. One portion is placed in cassette for routine processing. Another section is serially sectioned and labeled in preparation for BRCA-1BRCA-2 gene analysis." Can we bill 88305 and 88387?

Massachusetts Subscriber

Answer: Yes, the documentation you present should warrant reporting both 88305 (Level IV - Surgical pathology, gross and microscopic examination, lymph node, biopsy) and 88387 (Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies [e.g., nucleic acid-based molecular studies]; each tissue preparation [e.g., a single lymph node]), but there are a couple of caveats.

Watch edits: Medicare's Correct Coding Initiative (CCI) bundles 88387 as a column 2 code with 88305. Some experts maintain that because the pathologist in this case performs distinct services on uniquely identified and processed sites from a single lymph node specimen, you can override the edit pair with modifier 59 (Distinct procedural service). This reasoning is similar to touch-prep coding, when pathologists can report multiple units of 88161 (Cytopathology, smears, any other source; preparation, screening and interpretation) for touch preps from uniquely identified margins from a single specimen.

Caution: You should not report 88387 to capture the service of routine grossing activity that is an integral part of any surgical pathology service reported with codes 88302-88309 (Level ...Surgical pathology, gross and microscopic examination).