Pathology/Lab Coding Alert

Question: If the pathologist examines a lung specimen that the surgeon identifies as a -lung wedge resection,- what code should we report? The -biopsy- vs. -resection- terminology has us confused.


Maine Subscriber

Answer: The terminology difference, which can be confusing, stems from the fact that the CPT surgery section refers to a lung wedge specimen as a -resection,- while the pathology section refers to the same specimen as a -biopsy.- Look at these codes to see the terminology difference: 32500 (Removal of lung, other than total pneumonectomy; wedge resection, single or multiple) and 88307 (Level V--Surgical pathology, gross and microscopic examination, lung, wedge biopsy).

The pathology section provides a different code  for a lung resection (88309, Level VI--Surgical pathology, gross and microscopic examination, lung-- total/lobe/segment resection), so you do need to be  able to distinguish the specimens despite this terminology overlap.

Key: Look for the term -wedge- to determine that the specimen warrants 88307, regardless of whether the surgical report uses the term -resection.- You-ll generally find that the surgeon reports the procedure as -wedge resection of lung.- If the surgeon does not use the term -wedge,- your pathologist must determine if the specimen is a biopsy or segmental resection based on indicators such as specimen size and complexity.

Diagnosis irrelevant: Although the surgeon typically reserves wedge resections for lesions that he expects to be benign, the specimen may turn out to be cancerous. Regardless of your pathologist's final diagnosis, you should not upcode a lung wedge specimen to 88309.

Understand biopsy: Don't let the -biopsy- terminology confuse you either. CPT lists lung biopsies other than a -wedge- as an 88305 service (88305, Level IV--Surgical pathology, gross and microscopic examination, lung, transbronchial biopsy). Make sure you use 88307 for wedge specimens to accurately capture your pathologist's level of service.