Pathology/Lab Coding Alert

Question: What should the code be for pieces of colon tissue known as colon donuts if submitted separately from the main specimen when they are removed either during cancer surgeries or for benign conditions such as diverticulosis?

Kentucky Subscriber

Answer: If a colon donut is submitted for individual examination and diagnosis, separate from a colon surgery, it is an unlisted specimen and should be assigned to the code which most closely reflects the physician work involved when compared to other specimens assigned to that code, according to CPT direction for surgical pathology. The colon donut is often submitted as the true surgical margin following a colon resection for cancer. If that is the case, the surgeon should separately identify the colon donut and request individual diagnosis of the specimen. In fact, you would expect the diagnosis for this specimen to be different from the colon resection because it should represent a clear surgical margin. The work involved in evaluating this specimen would probably justify coding 88305 (level IV - surgical pathology, gross and microscopic examination; colon, biopsy), similar to a colon biopsy.

However, if the surgical note does not identify the need for separate evaluation, coding the colon donut separately would be inappropriate. This is why complete and accurate medical documentation is so crucial to correct coding.

Also, a colon donut may be submitted incidental to a resection for a benign condition (88307, level V, surgical pathology, gross and microscopic examination; colon, segmental resection, other than for tumor) such as diverticulosis (562.1x). Many coders believe that these donuts should be considered bundled with the colon specimen, even if they are submitted in separate containers, unless the surgeon specifically requests individual examination.

If one or multiple colon tissue specimens are sub-mitted for biopsy to aid the surgeon in determining the course of surgery, these would all be considered an 88305. However, if the multiple specimens are separately identified as to their location and require individual examination and pathologic diagnosis, each is coded as 88305 if submitted for biopsy.

If the surgery proceeds to a segmental or total resection for cancer, that specimen would be coded as 88309 (level VI - surgical pathology, gross and microscopic examination; colon, segmental resection for tumor, or colon, total resection) in addition to the code for the colon donut. If there is a segmental resection other than for tumor, this would be coded as 88307.