Pathology/Lab Coding Alert

Question: How should we code for tonsils and adenoids submitted under the following three conditions?

Massachusetts Subscriber

Answer: To correctly code these scenarios, you must apply three principles:

1. Report separately identified tonsils individually.

2. Bundle adenoids with at least one of the tonsils.

3. Differentiate between a biopsy and a tonsillectomy specimen.

Based on these rules, there is more than one correct way to code each of your examples and you might even code all three examples the same way.

Regardless of whether they are in the same container, if the surgeon separately identifies right and left tonsillectomy, you should report two units of 88304 (Level III Surgical pathology, gross and microscopic examination, tonsil and/or adenoids). You might code all three of your examples this way if the surgeon uses a stitch or other marker to differentiate the right and left tonsils in your first two scenarios. The code definition bundles the adenoids with the tonsil. On the other hand, if examples 1 and 2 are a tonsillectomy in which the surgeon does not separately identify the tonsils, you should report one unit of 88304.

The coding is different if the surgeon submits the tissue as a biopsy for possible neoplasm evaluation as opposed to normal tissue submitted from a tonsillectomy. Report a tonsil biopsy as 88305 (Level IV Surgical pathology, gross and microscopic examination, tonsil, biopsy). If you receive both tonsils for biopsy, separately identified, report 88305 x 2.