Pathology/Lab Coding Alert

It all comes down to separate specimens, experts say

One lobe or two? The answer may surprise you - and that's just the first question that complicates thyroid coding.

Study the following six guidelines to make sure you're getting all the payment you deserve when your pathologist examines thyroid specimens and associated tissues. 1. Timing Is Everything for Thyroid Lobes When your pathologist examines both thyroid lobes, should you report one or two units of CPT 88307 (Level V - Surgical pathology, gross and microscopic examination; thyroid, total/lobe)? That depends, says Pamela Younes, MHS, HTL(ASCP), CPC, assistant professor at Baylor College of Medicine in Houston. "If the surgeon performs a total thyroidectomy and submits the entire thyroid for pathological examination, you should report 88307 for the specimen," she says. But surgeons often remove only one lobe, and the pathologist should also report 88307 for examining a single thyroid lobe.

Sometimes the surgeon performs a hemithyroidectomy, and then based on intraoperative findings, separately removes and submits the remaining thyroid lobe in the same operative session. "When the pathologist separately receives and examines the left and right thyroid lobes, you should report two units of 88307," Younes says.

Red flag: You'll need to follow your payer's convention to indicate that you've performed two distinct services, such as reporting 88307 x 2 or listing the second code with modifier -59 (Distinct procedural service).

Some experts caution that you shouldn't always separately report two hemithyroidectomies. If the pathology report treats the two lobes as one specimen and provides one diagnosis, you should not distinguish the lobes for coding purposes. You should only report a separate code if the pathology report shows the work. 2. Biopsy Unlisted? Report It Anyway Pathologists sometimes receive thyroid biopsy specimens - such as a needle-core biopsy, excisional biopsy, or a thyroid nodule. But "thyroid biopsy" is not among the 185 listed specimens under CPT surgical pathology codes 88302-88309.

CPT instruction for surgical pathology states that "Any unlisted specimen should be assigned to the code which most closely reflects the physician work involved ..." Younes says that means you should assign thyroid biopsy to 88305 (Level IV - Surgical pathology, gross and microscopic examination). Code 88305 commonly describes biopsies, with over half the listed 88305 specimens representing various tissue biopsy samples. 3. Capture FNA Steps Physicians often use fine needle aspiration (FNA) rather than biopsy to assist in thyroid diagnosis.

Report thyroid FNA just as you'd report any other FNA: Bill for each step that your pathologist carries out. Look for documentation of any of the following steps that your pathologist might perform:

 FNA procurement - 10021 (Fine needle aspiration; without imaging guidance). "Report this only if the pathologist extracts the cells," [...]