Pathology/Lab Coding Alert

Question: When our pathologists prepare already-diagnosed tissue for EGFR, KRAS, or BRAF testing, which code most accurately represents the pathologists’ dissection work?

Tennessee Subscriber

Answer: There are several code choices, depending on how your pathologist preps the tissue, and how the tissue has previously been processed and stored. You might choose from the following codes:

• 88363 — Examination and selection of retrieved archival (i.e., previously diagnosed) tissue(s) for molecular analysis (e.g., KRAS mutational analysis)
• 88380 – Microdissection (i.e., sample preparation of microscopically identified target); laser capture
• 88381 — ... manual.

If the pathologist examines and selects archival tissue for a molecular test, report 88363. If the pathologist performs microdissection to prepare the sample for molecular pathology testing, either manually or using laser capture technique you should choose either 88381 or 88380.

Beware edits: Correct Coding Initiative (CCI) bundles 88363 with 88380 and 88381. Select only the most extensive procedure your pathologist uses in the tissue prep for molecular testing.

Macroscopic unlikely: Because you state that the tissue has already been diagnosed, you’ll almost certainly use one of the above codes. However, you should be aware that CPT^® provides the following codes to capture a pathologist’s work preparing tissue for molecular studies when the pathologist performs the service on fresh tissue using macroscopic techniques:

• 88387 — Macroscopic examination, dissection, and preparation of tissue for nonmicroscopic analytical studies (e.g., nucleic acid-based molecular studies); each tissue preparation (e.g., a single lymph node)
• +88388 — ... in conjunction with a touch imprint, intraoperative consultation, or frozen section, each tissue preparation (e.g., a single lymph node) (List separately in addition to code for primary procedure).

When preparing a specimen for molecular studies, 88387 and +88388 refer to specific pathologist macroscopic work that takes place before the pathologist performs the microscopic examination (such as 88305, Level IV - Surgical pathology, gross and microscopic examination …).