Pathology/Lab Coding Alert

Question: Is giant cell tumor of the tendon sheath a benign or malignant neoplasm? I-m having trouble finding the correct ICD-9 code and wonder if the type of neoplasm affects the CPT code for the pathologist's tissue examination.


Connecticut Subscriber

Answer: The correct code for the condition is 727.02 (Giant cell tumor of tendon sheath). ICD-9 does not classify this as a neoplasm at all, so the name can be misleading if you-re trying to find the condition in the code book.

Do this: You should always approach ICD-9 coding by first looking up the condition name in the ICD-9 alphabetic index (Volume 2). You should not start with the neoplasm table, even if you suspect the condition is a neoplasm. The index entry will often describe the morphologic (histologic) variety and help you select the proper column (such as malignant, benign, etc.) when you do turn to the neoplasm table.

If you began your search this way, you would find an entry for -Giant cell tumor of tendon sheath- in the index -quot; 727.02. You can then turn to the
tabular list (Volume 1) and read any associated notes to ensure that you have selected the proper code.

If you began with the neoplasm table, you would look up -tendon sheath,- which instructs you to -see neoplasm, connective tissue.- When you turn to connective tissue on the neoplasm table, you still wouldn't find a reference to giant cell tumor of the tendon sheath, which is the condition you-re looking for.

Don't change procedure: Unlike many other tissue specimens, CPT lists tendon sheath only under one surgical pathology code--88304 (Level III--Surgical pathology, gross and microscopic examination; tendon/tendon sheath). You would not select a different code for the tendon sheath specimen, regardless of diagnosis. The fact that the pathologist diagnoses giant cell tumor is not relevant to the CPT code selection.