Pathology/Lab Coding Alert

Question: Our pathologist examined a very large lipoma located primarily in the upper back, but extending into the right shoulder area. He processed four tissue blocks for the large specimen, and spent far more time than an 88304 service. Can we report the service using 88305?

Oklahoma Subscriber

Answer: No, you should not upcode to another surgical pathology level for an exceptionally difficult specimen. You must report a lipoma exam using surgical pathology code where the specimen is listed: 88304 (Level III, Surgical pathology, gross and microscopic examination, soft tissue, lipoma).

Check out 22: If the pathologist documents that this is a particularly large lesion requiring additional procedural work, you might consider appending modifier 22 (Increased procedural services) to the appropriate code.

If you expect additional payment when using modifier 22, you'll need to document the increased complexity of the particular case.

CPT® specifically recommends that physicians document the reason for the additional effort, such as "increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required." In your example, documenting additional blocks and time relative to a typical 88304 service might justify additional pay.

Although you can add modifier 22 based only on the description of the work in the body of the note, it is practically impossible to get additional pay if you don't quantify the extra effort on the claim form.