Pathology/Lab Coding Alert

Question: How should we code this scenario for specimens listed A-E?
 
A -- deep margin breast examination with frozen sections
B -- inferior margin breast examination with frozen sections
C -- superior margin breast examination with frozen sections
D -- mastectomy with axillary tail
E -- part of left axillary content.

Massachusetts Subscriber Answer: The case you describe involves three separately identified and diagnosed surgical margins, as well as a complete mastectomy specimen. For the surgical margins, the pathologist performed intraoperative consultations with frozen sections and a separate surgical pathology examination for each specimen. Because CPT bundles regional lymph nodes with mastectomy, the parts you list as D and E actually represent a single specimen even if the surgeon submitted them separately. Code the scenario as follows:

A. 88331 -- Pathology consultation during surgery; first tissue block, with frozen section(s), single specimen
    88305 -- Level IV - Surgical pathology, gross and microscopic examination, breast, biopsy, not requiring microscopic evaluation of surgical margins

B. 88331 and 88305

C. 88331 and 88305

D/E. 88309 -- Level VI - Surgical pathology, gross and microscopic examination, breast, mastectomy - with regional lymph nodes.
 
You should report 88331 for each margin frozen-section consult regardless of the number of slides prepared. If one of the margins requires multiple blocks, you should report 88332 (... each additional tissue block with frozen section[s]) for each block in addition to the 88331 for that specimen. The 88332 is only for the second block of a single specimen, not for separate frozen section specimens. This is why you should not code the scenario as A. 88331, B. 88332, C. 88332, although this is a common error.