Pathology/Lab Coding Alert

Question: Our pathologist received a specimen labeled "right breast mass," and the pathology report lists the specimen as "right breast lesion." But the final diagnosis is "right breast, lipoma  (214.1, Lipoma, other skin and subcutaneous tissue)." My pathologist says this is an 88305, but I think it's an 88304. How should I code?

Arkansas Subscriber

Answer: You are correct that the appropriate code in this scenario is 88304 (Level III -- Surgical pathology, gross and microscopic examination, soft tissue, lipoma).

You should choose the procedure code based on the final pathologic diagnosis, when it is known. Lipoma is a listed specimen, so you should use the surgical pathology code for that specimen regardless of the clinical diagnosis or the name the surgeon or pathologist used for the mass prior to diagnosis. In fact, you should list 88304 for the pathologist's exam of any lipoma that you would report with ICD-9 category 214 (Lipoma), including myelolipoma or hibernoma, regardless of the number of tissue blocks or the extent of the exam.