Pathology/Lab Coding Alert

Question: I noticed that CPT lists lymph nodes as pathology specimens under 88305 and 88307. How do I know which code to use, and what is the difference between a lymph node and a sentinel lymph node?

Kentucky Subscriber

Answer: The CPT definitions for lymph node specimens are as follows:

 88305 -- Level IV - Surgical pathology, gross and microscopic examination, lymph node, biopsy

 88307 -- Level V - Surgical pathology, gross and microscopic examination, lymph nodes, regional resection

 88307 -- Level V - Surgical pathology, gross and microscopic examination, sentinel lymph node.

Code 88305 describes a single lymph node that the physician submits to the pathologist for standard examination and diagnosis. You should report multiple units of 88305 if the surgeon submits multiple lymph nodes and individually identifies each node (for example, based on location).

More commonly, when the pathologist receives multiple lymph nodes, the surgeon does not separately identify each node but indicates the region from which he removed all the nodes. In these cases, you should report code 88307 for a regional resection. 

You should also report 88307 for a sentinel lymph node exam. Although the sentinel node is a single lymph node, the surgeon identification and pathologist processing makes the sentinel node a different type of specimen from a regular lymph node exam.

The surgeon and radiologist identify the sentinel node by injecting the primary cancer site with a radioisotope and a dye. They follow these markers to identify the first lymph node in a particular region that "drains" from the cancer site. This is the sentinel node.

By examining the sentinel node more thoroughly than a regular lymph node specimen, the pathologist can identify occult metastases, which can indicate whether the surgeon should proceed with a regional lymph node resection.

The pathologist's sentinel lymph node exam typically involves preparation of numerous paraffin blocks, with serial sectioning and special histochemical staining of each block. This method requires the pathologist to examine many more slides than he would typically examine for a regular lymph node biopsy. That is why CPT added sentinel lymph node as a specimen under a higher surgical pathology level -- 88307 compared to 88305 for a regular lymph node biopsy. 

You should notice that CPT lists lymph nodes as a component of certain other surgical pathology specimens such as 88309 (Level VI - Surgical pathology, gross and microscopic examination, breast, mastectomy - with regional lymph nodes) and 88309 (... Larynx, partial/total resection - with regional lymph nodes). You should not report a separate lymph node biopsy or a lymph node resection with one of these codes when the node(s) are part of the specimen resection.