Pathology/Lab Coding Alert

Don’t lose $71 that your pathologist deserves.

Here’s something that doesn’t happen every day — but maybe it happens often enough that you could capture additional, legitimate pay for your pathology practice if you knew how to handle it:

Case: Pathologist receives tissue in a single container identified by the surgeon as “thyroidectomy.” During processing, the pathologist identifies a parathyroid glad in the resected tissue.

Look for Separate Examination and Diagnosis

The question raised by this case is, can you “unbundle” the parathyroid gland from the thyroidectomy specimen even though the surgeon didn’t separately identify and submit it for pathologic evaluation?

The answer depends on what your pathologist does and documents. Here’s an example: 

Specimen A: Thyroidectomy, processed in two cassettes 

Diagnosis A: Noted frond-like projections in follicular cells and Psammoma bodies consistent with Papillary thyroid cancer.  

Specimen B: Parathyroid gland

Diagnosis B: Noted chief cells, fat striations, and thin, fibrous capsule dividing gland into lobules. 

Do this: “For specimen A, report the thyroidectomy exam using 88307 (Level V - Surgical pathology, gross and microscopic examination, Thyroid, total/lobe),” says R.M. Stainton Jr., MD, president of Doctors’ Anatomic Pathology Services in Jonesboro, Ark.

Based on documentation of a separate specimen exam and diagnosis, even though the parathyroid gland did not show distinct pathology, you can additionally report 88305 (Level IV - Surgical pathology, gross and microscopic examination, Parathyroid gland) in this case. 

Earned: By appropriately documenting the parathyroid exam, your pathologist stands to gain an additional $70.57 based on the 2014 Medicare Physician Fee Schedule national amount using conversion factor 35.8228.

Distinguish Lymph Nodes, Too

Although CPT® bundles lymph nodes with some surgical pathology specimens, the thyroid gland isn’t one of them. 

Just like the parathyroid, if your pathologist separately examines and diagnoses a lymph node submitted with a thyroidectomy specimen, you can report an additional unit of 88305 (… Lymph node, biopsy).

Coder tip: If the pathologist performs a sentinel lymph node biopsy, which entails additional sectioning and staining to determine the presence of possible metastasis to the first-draining lymph node, you should report 88307 (… Sentinel lymph node) instead of 88305.