Pathology/Lab Coding Alert

Question: How should I code a lung lobectomy specimen, including two frozens -- one on the bronchial margin and one on a block from the central tumor mass for preliminary diagnosis?

Tennessee Subscriber

Answer: The correct code for the pathologist's exam of the lobectomy specimen is 88309 (Level VI -- Surgical pathology, gross and microscopic examination, lung - total/lobe/segment resection).

For the frozen sections, you should report 88331 (Pathology consultation during surgery; first tissue block, with frozen section[s], single specimen) and 88332 (... each additional tissue block with frozen section[s]).

CPT lists three lung specimen codes -- 88309, 88307 (Level V -- Surgical pathology, gross and microscopic examination, lung, wedge biopsy) and 88305 (... transbronchial biopsy).

Because the listed specimen is "lobectomy," you can see that biopsy codes 88305 and 88307 are not appropriate. In contrast, the 88309 definition includes "lung lobe" resection as one of the specimen options.

Code frozens per block: Because the pathologist examines two distinct frozen section blocks from this specimen -- one from the bronchial margin and one from the central tumor mass -- you'll need to list each separately.

The unit of service for 88331 and 88332 is the frozen tissue block, not the specimen or the frozen section slide. You have to keep track of specimens, too, because counting blocks starts over every time you encounter a new specimen.

Do this: Use 88331 to report the pathologist's evaluation during surgery of any number of frozen sections from the first (or only) tissue block from a specific specimen -- the central tumor mass in your case. When the pathologist examines frozen section slides from an additional frozen tissue block from the same specimen -- the bronchial margin in your case -- you should use 88332.