Pathology/Lab Coding Alert

Question: When coding the pathology examination of lymph nodes, at what point or number does the code change from 88305 to 88307? We were told that a single lymph is coded 88305, but when two or more are removed in the same specimen, it can be upgraded to 88307. Is this correct is there a definition of when it becomes a regional resection? Our pathologists are frequently asked to examine lymph nodes from different areas, such as obturator and pelvic, and they will be submitted with descriptions of where they came from as right, left, etc.

Pam Dickerson
Tucson, Ariz.

Answer: Clearly, if a single lymph node biopsy is examined, the correct code is 88305 (level IV surgical pathology, gross and microscopic examination lymph node, biopsy). If two lymph nodes were examined, each separately identified from different anatomic areas as in your last example, the correct code is 88305 x 2, or 88305 and 88305 with -59 (distinct procedural service) to designate the same service for different areas or sites.

It becomes appropriate to code 88307 (level V surgical pathology, gross and microscopic examination, lymph nodes, regional resection) when multiple lymph nodes from the same region are submitted as a single specimen. CPT does not define a number of lymph nodes required to represent a regional resection. However, because the term refers to the excision of the lymph nodes in an entire area, it would be unusual to have such a specimen with only two nodes.

Remember that the resection of regional nodes is considered bundled with certain surgical specimens. For some specimens, the lymph nodes are listed as included in the CPT description, such as 88309 (breast, mastectomy with regional lymph nodes) or 88309 (larynx, partial/total resection with regional lymph nodes). CPT Assistant of fall 1993 further clarifies the issue with the statement, In coding for surgical pathology level VI (88309) specimens, the general policy is that lymph node(s) are not to be separately coded when the node(s) are a part of the resected 88309 specimen. That is, if the node(s) are attached to the primary specimen, they would not be coded separately.