Pathology/Lab Coding Alert

Question: Is a cervical LEEP always a conization specimen? Can we code for two LEEPs if the surgeon submits them in separate containers?

South Carolina Subscriber

Answer: A cervical LEEP (loop electrocautery excision procedure) is not always the same as a cervical conization specimen. Instead, it may be a cervical biopsy specimen. The distinction is important, because pathologists use different codes for cervical conization and cervical biopsy, as follows:

- 88305 -- Level IV " Surgical pathology, gross and microscopic examination, cervix, biopsy

- 88307 -- Level V " Surgical pathology, gross and microscopic examination, cervix, conization.

Difference pays: With a payment difference of $80.43 between 88305 and 88307 (based on the global non-facility 2009 Medicare physician fee schedule), you-ll want to be sure to choose the right code.

Recognize cones: A conization refers to a cone-shaped excision of cervical tissue for diagnostic study, usually taken with a scalpel. The pathologist typically sections the cone by quadrants, resulting in a more extensive dissection than a biopsy. That's why the conization pays more.

Know LEEPs: Sometimes the surgeon excises cervical tissue using the LEEP method instead of a scalpel, but the specimen from a LEEP procedure could be a biopsy or a conization.

Do this: If the surgical note does not clarify the intended specimen, the pathologist must determine the level of work involved in the tissue exam and document the specimen as a cone or biopsy and code accordingly.

Documentation counts: Pathologists should clarify the specimen for coding purposes by using terms such as "LEEP biopsy" or "LEEP conization" in the pathology report.

Handle multiple specimens: If the surgeon submits two or three separate cervical LEEP specimens, you should code each individually according to the work required -- either as biopsy or conization. That might mean you code for multiple LEEPs and/or multiple biopsy specimens. You should never bundle separate specimens into a single 88307 as though they are portions of a single conization.