Pathology/Lab Coding Alert

Question: Our pathologist examined an appendix with carcinoma that was extremely complex, involving far more cassettes than he would normally examine for an appendicitis specimen. I know that an appendix is normally 88304, but can we report this particular specimen as 88305, since CPT says that specimens "represent additional ascending levels of physician work"?

Illinois Subscriber

Answer: You should not report the appendix with carcinoma as 88305 (Level IV - surgical pathology, gross and microscopic examination). Although, as you said, CPT states that for codes 88304-88309, specimens "represent additional ascending levels of physician work," CPT also states that "Levels 88302 through 88309 are specifically defined by the assigned specimens."

CPT actually assigns appendix to two levels, neither of which is the code you asked about -- 88305. The two levels are 88302 (Level II - surgical pathology, gross and microscopic examination, appendix, incidental) and 88304 (Level III - surgical pathology, gross and microscopic examination, appendix, other than incidental). The pathologist examines an incidental specimen simply to confirm organ identification and absence of disease, which clearly does not represent the situation you describe. Use 88304 for the appendix with carcinoma, regardless of the physician work involved.

You can only assign an unlisted specimen to the code that most closely reflects the physician work involved. Otherwise, you must report the assigned code for a listed specimen.

If the pathologist documents that the specimen involved an unusually extensive level of work, you can append modifier -22 (Unusual procedural services). Some Medicare carriers and other payers will not increase payment when you use this modifier, but some may, when you provide adequate documentation.