Pathology/Lab Coding Alert

Question: We have not been able to unbundle certain pathology codes . For example, a colectomy or gastrectomy specimen with malignant tumor has been  coded 88309, which includes the lymph-node dissection that is required for proper analysis of this specimen. I know that we cannot unbundle mastectomy with axillary lymph nodes or larynx with lymph nodes. Is it ever possible to charge the lymph-node portion of the dissection separately from the main specimen?

California Subscriber
 
 Answer: Code 88309 (level VI - surgical pathology, gross and microscopic examination) specifically lists lymph nodes as a bundled part of the specimen when removed with breast or larynx. The reason is the lymph nodes are almost always attached and removed as an integral part of a radical mastectomy or a neck resection. Although not listed in CPT as bundled with lymph nodes, a colon resection (88309) also typically includes mesenteric lymph nodes as an integral part of the specimen. That is why lymph nodes should not be reported separately for these specimens.
 
CPT Assistant Fall 1993 states, "In coding for surgical pathology level VI (88309) specimens, the general policy is that lymph nodes are not to be separately coded when the nodes are a part of the resected 88309 specimen." On the other hand, some resections would not typically include lymph nodes as an integral part of the specimen, such as prostatectomy, hysterectomy, tonsillectomy, etc. If regional lymph nodes are removed in addition to these specimens, they would represent a separate 88307 (lymph nodes, regional resection) evaluation service. For example, a pathologist might receive the prostate and the right iliac lymph nodes, which would be reported as 88309 (prostate, radical resection) and 88307. The pathologist must understand the presentation of the case and determine if the lymph nodes are integral or separate from the specimen in accordance with the general policy.