Pathology/Lab Coding Alert

Question: Two specimen containers arrived for diagnosis, the first containing tissue identified as an "umbilical hernia." The pathologist identified the contents of this container as an umbilical hernia sac, and a strangulated loop of small intestine, for which the pathology report documents separate evaluation and diagnosis. The surgeon identified the specimen in the second container as a large piece of dermal tissue for a "scar revision," which the pathologist confirmed. How should we code this?

Ohio Subscriber

Answer: Even though your pathologist received only two containers, you should code this case as the following three specimens:

• 88302 (Level II - Surgical pathology, gross and microscopic examination,... skin, plastic repair...) for the scar revision tissue
• 88302 (... Hernia Sac ...) for the hernia sac
• 88307 (Level V - Surgical pathology, gross and microscopic examination ... Small intestine, resection, other than for tumor ...) for the strangulated small intestine tissue.

Skin: Regardless of the size of the skin specimen, you should not report this scar revision tissue using any of the following CPT^® codes that represent different types of skin specimens:

• 88304, Level III - Surgical pathology, gross and microscopic examination, ... skin - cyst/tag/debridement...
• 88305, Level IV - Surgical pathology, gross and microscopic examination, ... skin, other than cyst/tag/debridement/plastic repair...

Hernia: During a hernia repair, surgeons typically try to reduce the hernia and excise only the remaining hernia sac. If the intestine is strangulated to the point of ischemia, causing tissue death to the portion of intestine, then the surgeon must remove that tissue. When the pathologist receives simply a hernia sac, it is appropriate to code 88302. But if the pathologist must separately cut open and evaluate the ischemic small intestine, the service represents a distinct specimen exam that requires more work than a hernia sac evaluation. Code 88307 best represents the pathologist's evaluation of the small intestine specimen.