Pathology/Lab Coding Alert

Question: Sometimes our pathologist performs an exam of a kidney biopsy to ensure that the specimen contains sufficient glomeruli for further examination and diagnosis. The pathologist reports the findings to the surgeon so that he can obtain an additional biopsy, if needed. But instead of our pathologist performing the kidney biopsy exam, we package the biopsy and send it to an outside lab for analysis. Can we charge for a gross exam and an intraoperative consult?

Texas Subscriber

Answer: No, you should not charge for both a gross exam (88300, Level I -- Surgical pathology, gross examination only) and an intraoperative consultation (88329, Pathology consultation during surgery). You should code the case as 88329. When the pathologist examines the renal biopsy intraoperatively, the work typically involves a gross exam as well as low-magnification inspection to determine if the specimen contains cortex and/or medulla. This is crucial to the value of the biopsy for diagnosis, because the cortex contains glomeruli while medullary tissue does not. A glomerulus is a cluster of capillaries within a capsule that forms the basic filtration unit of the kidneys, so evaluating glomeruli is essential to diagnosing kidney pathology.

The correct code for an intraoperative consultation that doesn't involve frozen sections or touch preps is 88329. The code includes any gross and microscopic work that the pathologist performs to provide a report to the surgeon while the patient is still in the operating room.

Scratch 88300: You should not additionally report 88300 for this scenario. The intraoperative consult includes the gross exam. And the lab where you send the specimen will perform the 88305 service (Level IV -- Surgical pathology, gross and microscopic examination, kidney, biopsy), whic also includes a gross exam.