Pathology/Lab Coding Alert
Lymph Nodes to Bundle or Not to Bundle
Question: We bill axillary node dissections and radical neck dissections as 88307. How should we report pelvic node dissections received with prostatectomy specimens? Should we report 88307 in addition to the prostatectomy? What if we receive left and right separately identified? Indiana Subscriber Answer: CPTspecifically bundles lymph nodes with some surgical pathology specimens, such as larynx (88309, Level VI Surgical pathology, gross and microscopic examination, larynx, partial/total resection with regional lymph nodes), but prostate is not one of them. For example, if you receive left and right iliac node resections, each separately identified and comprised of multiple nodes (usually in fatty tissue), report two units of 88307 (Level V Surgical pathology, gross and microscopic examination, lymph nodes, regional resection). You would report this in addition to the neoplastic prostate resection (88309, prostate, radical resection). Attach modifier -59 (Distinct procedural service) to each 88307 because the specimens come from two different regions.
Lymph nodes normally are not attached as a part of a prostate specimen. If the surgeon submits one or multiple regional lymph node resections in addition to the prostate specimen, the pathologist examines each separately to evaluate metastatic involvement. This constitutes a separate service for each dissection.
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