Pathology/Lab Coding Alert

Question: We used to bill sentinel lymph node biopsy as CPT 88305, plus additional codes for special stains, etc. We are now billing sentinel lymph node biopsy with 88307 since it was added to the specimen list in 2001. Does the fact that the sentinel node was assigned to a higher code mean that the additional special stain and evaluation services are included in 88307, or can we still bill them separately?

Wyoming Subscriber
 
Answer: The sentinel lymph node biopsy service (88307, level V - surgical pathology, gross and microscopic examination, sentinel lymph node) refers to the accession, pathologic examination and reporting of results for a sentinel node. Unlike a regular lymph node biopsy, the procedure for a sentinel node typically involves four to five paraffin blocks prepared from a single sentinel node specimen, with multiple serial sections taken at various levels for H and E (hematoxylin/
eosin) staining. The multiple blocks and slides are not reported separately, but are bundled with the 88307 service.
 
Sentinel node biopsy was added to the 88307 specimen list because it involves this level of work beyond a regular lymph node biopsy (88305). Pathologic evaluation of the sentinel node is reported in addition to the code for evaluation of the primary surgical specimen, e.g., breast (88307) or skin lesion (88305).
 
According to CPT direction in the introduction to the surgical pathology section, 88300-88309 do not include special staining or other services that might be provided. In addition to the gross and microscopic examination of the lymph node, the sentinel node is also subjected to an intense study for occult metastases. During the serial sectioning, multiple slides from various levels are prepared with a histochemical stain such as S100. For these slides, report 88342 (immunocytochemistry [including tissue immunoperoxidase], each antibody) once.
 
Even if two slides are prepared for each of four paraffin blocks, only one unit of 88342 can be reported for a single stain, because the specimen is the unit of service for surgical pathology. Code 88342 should not be coded separately for each slide, only for each antibody. The distinction is clarified in CPT Assistant, Winter 91:18, which states, each antibody used in an immunocytochemistry study of a specimen should be separately coded as 88342.