Pathology/Lab Coding Alert

Question: The pathologist examined two sentinel lymph nodes, marked and separately identified by location, in addition to a mastectomy specimen. Can we code the sentinel node(s) separately even though CPT bundles lymph nodes with breast?

Tennessee Subscriber

Answer: Yes, you can separately report each sentinel node exam in addition to the mastectomy exam.

You don't specify the type of mastectomy specimen, but we-ll assume it is a partial or simple mastectomy since you make no mention of other lymph nodes.

Code the case like this: 88307 x 3. You should report one unit of 88307 for the mastectomy (Level V -- Surgical pathology, gross and microscopic examination; breast, mastectomy -- partial/simple). The other two units of 88307 are for two sentinel lymph nodes (- sentinel lymph node).

Add-on these services: The sentinel node biopsy typically includes examining cytokeratin-stained slides that the lab prepares from multiple levels of serially sectioned tissue. You can list the stain once per antibody per specimen.

That means you-d report 88342 (Immunohistochemistry [including tissue immunoperoxidase], each antibody) once for each sentinel node, regardless of the number of slides from each node -- 88342 x 2.

-- Reader Questions were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctors- Anatomic Pathology Services in Jonesboro, Ark.