Pathology/Lab Coding Alert

Question: Occasionally, one of our pediatric cardiothoracic surgeons sends us a normal thymus gland that he has removed to enable better access for heart surgery. This is an incidental thymectomy the tissue is normal there is no tumor. We routinely put through one section for documentation purposes. The only CPT code that mentions thymus is 88307. Logically, normal thymus should be level II, III or IV (88302, 88304 or 88305) certainly not level V (88307). What code would you suggest for normal thymus?

Michael Kornstein, MD
Richmond, Va.

Answer: The logic of CPT does not include the assessment of apparently normal tissue as a by-product of another surgery. As you stated, you should not code an 88307 (level V surgical pathology, gross and microscopic examination; thymus, tumor) for an incidental thymus that does not involve a tumor and does not require the level of work that is involved in examination of a thymus tumor. But you are not confined to the listed specimens for surgical pathology.

The code descriptors are provided as guidelines, and the code reported for specimens that are not listed should reflect the level of comparable work. In other words, when the pathologist evaluates an incidental thymus, he or she is evaluating a specimen that is not listed (a normal thymus, not a thymus tumor). So the pathologist should determine the surgical pathology service level on the basis of the work involved. As the CPT direction for surgical pathology codes states, Any unlisted specimen should be assigned to the code which most closely reflects the physician work involved when compared to other specimens assigned to that code.

For example, the pathologist who evaluates the incidental thymus might determine that the level of work for the specimen is similar to the level of work for a tonsil, which has a similar histology and level of complexity. If so, the appropriate code would be 88304 (level III surgical pathology, gross and microscopic examination). On the other hand, the pathologist may determine that the level of work is similar to other listed incidental surgical specimens, such as an incidental appendix (88302, level II surgical pathology, gross and microscopic examination; appendix, incidental). In that case, coding 88302 would be appropriate. For an unlisted specimen, the pathologist must assign the code that most closely describes the work involved as reflected in the medical record.