Pathology/Lab Coding Alert

Question: Which diagnosis code should we use for  evaluation of abnormal products of conception or a specimen from an ectopic pregnancy? We are receiving denials for 88305 when reporting diagnosis codes 630, 631 or 633, and are told to use either 632 or one of the 634 codes.

Missouri Subscriber
 
Answer: Abnormal products of conception are reported with 630-634, depending on the specific circumstances. The bottom line is evaluation of almost all abnormal products of conception is reported as 88305. Evaluation of products of induced abortion (635-636) is reported as 88304 (level III - surgical pathology, gross and microscopic examination, abortion, induced). The following is a description of each ICD-9 code along with the associated CPT surgical pathology code and listed specimen.
 
630 (hydatidiform mole) describes an abnormal product of conception that appears as an intrauterine polycystic mass with characteristic chorionic villi proliferation and degeneration. For evaluation, report 88305 (level IV - surgical pathology, gross and microscopic examination, endometrium, curettings/biopsy; or placenta, other than third trimester).
 
631 (other abnormal product of conception) describes other intrauterine abnormal products of conception such as a blighted ovum or fleshy mole a uterine mass consisting of fetal membranes, placenta and blood clots. For evaluation, report 88305 (level IV - surgical pathology, gross and microscopic examination, endometrium, curettings/biopsy; or placenta, other than third trimester).
 
632 (missed abortion) describes the retained products of conception following early fetal death (before completion of 22 weeks gestation). For evaluation, report 88305 (level IV - surgical pathology, gross and microscopic examination, endometrium, abortion - spontaneous/missed).
 
633.x (ectopic pregnancy) describes a fertilized egg that develops outside the uterus. The fourth digit of the code and the surgical pathology specimen evaluated depends on the location of the ectopic pregnancy.
 
633.0 (abdominal pregnancy). For evaluation, report 88305 (level IV - surgical pathology, gross and microscopic examination, placenta, other than third trimester; or abortion - spontaneous/missed).
 
633.1 (tubal pregnancy). For evaluation, report 88305 (level IV - surgical pathology, gross and microscopic examination, fallopian tube, ectopic pregnancy).
 
633.2 (ovarian pregnancy). For evaluation, report 88305 (level IV - surgical pathology, gross and microscopic examination, ovary with or without tube, non-neoplastic).
 
633.8 (other ectopic pregnancy) describes an ectopic pregnancy in several specific but highly unusual locations, and 633.9 (unspecified ectopic pregnancy) is used when the location is unreported. For pathology evaluation, report 88305, comparable to level IV - surgical pathology, gross and microscopic examination, placenta, other than third trimester; or abortion - spontaneous/missed.
 
634.xx (spontaneous abortion) describes the products of conception that are expelled spontaneously and prematurely. The fourth-digit divisions of this code refer to maternal complications such as genital tract infection, and the fifth-digit divisions describe whether the abortion is complete or incomplete. Neither of these impact the procedure code for pathology evaluation of the specimen, which is 88305 (level IV - surgical pathology, gross and microscopic examination, abortion - spontaneous/missed).
 
Although different specimen names accurately describe the specific abnormal product of conception, e.g., endometrium curettings, ovary, spontaneous abortion, fallopian tube, almost all are listed under 88305.