Pathology/Lab Coding Alert

Question: Is the CPT code for surgical pathology evaluation of breast tissue the same for a lumpectomy and an incisional biopsy? Is the size of the specimen the deciding factor in coding these services?

Ohio Subscriber

Answer: No, the codes for a lumpectomy and an incisional breast biopsy are not the same, and size is not the determining factor. Regardless of the size of the specimen, the lumpectomy is reported as 88307 (Level V Surgical pathology, gross and microscopic examination, breast, excision of lesion, requiring microscopic evaluation of surgical margins). The key to this specimen is that the surgeon attempts to remove the entire lesion in a lumpectomy, so the pathologist must provide additional evaluation to ensure that the surgical margins are clear.

On the other hand, in an incisional breast biopsy, the surgeon attempts only to sample the suspicious lesion for diagnostic purposes. The pathologist's work to evaluate the specimen is described by 88305 (Level IV Surgical pathology, gross and microscopic examination, breast, biopsy, not requiring microscopic evaluation of surgical margins). The pathologist does no additional work to ensure clear surgical margins for an incisional breast biopsy specimen.