Pathology/Lab Coding Alert

Question: A pathologist receives a lung wedge biopsy for immediate diagnosis. The pathologist examines the specimen and prepares three frozen sections to provide an intraoperative diagnosis. Based on the diagnosis, the surgeon proceeds with a lobe resection, and the pathologist consults to ensure the margins are clear. The pathologist selects portions of the margins, resulting in three blocks for frozen sections, and then evaluates the wedge biopsy and the lung resection. How should these services be reported?

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Answer: The evaluation of the lung biopsy is reported as 88307 (level V - surgical pathology, gross and microscopic examination, lung, wedge biopsy). The examination of the lung resection is reported as 88309 (level VI - surgical pathology, gross and microscopic examination, lung - total/lobe/segment resection).
 
The intraoperative consultations are reported as follows: 88331 (pathology consultation during surgery; first tissue block, with frozen section[s], single specimen) is reported for the first consultation on the biopsy that included three frozen sections. Code 88331 is reported once for the first block from the lobe resection evaluated for margin involvement, and 88332 (pathology consultation during surgery; each additional tissue block with frozen section[s]) is reported twice: once for each of the additional blocks from the lung resection evaluated for margin involvement.
 
Because this scenario involves multiple specimens from the same patient on the same day, modifier -59 (distinct procedural service) will clarify that each service is separate and that a single specimen is not being unbundled. The CPT explanation for modifier -59 states that it is for services that may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury.
 
Because the wedge biopsy and the lobe resection were separate excisions and represent separate specimens, each is individually reportable. Because the two units of 88331 represent separate specimens (and separate patient encounters), they are also separately reportable.