Pathology/Lab Coding Alert

Question: I’ve heard that we can charge 88307 instead of 88305 when our pathologist evaluates a single lymph node for a lymphoma workup. Is that accurate?

Arkansas Subscriber

Answer: Some experts state that you may bill 88307 (Level V - Surgical pathology, gross and microscopic examination…) for a lymphoma workup (lymphoma protocol) exam of a single lymph node.

Although a pathology exam of a single lymph node is typically an 88305 service (Level IV - Surgical pathology, gross and microscopic examination… Lymph node, biopsy), there are exceptions when the exam may warrant an 88307 service code. For instance, CPT^® lists sentinel lymph node as a specimen under 88307.

Lymphoma workup is not a listed specimen, but CPT^® instructions state that if the pathologist performs an unlisted specimen exam, it “should be assigned to the code which most closely reflects the physician work involved when compared to other specimens assigned to that code.”

When the clinician suspects lymphoma and submits a single, often enlarged lymph node for lymphoma evaluation, pathologists usually follow a set protocol that involves far more extensive evaluation than a lymph node biopsy exam. The specimen must be fresh and processed immediately, typically including touch preps and tissue snap frozen for immunophenotyping or molecular studies. The lymphoma protocol also often involves evaluation of numerous hematoxylin and eosin (H&E) slides beyond what is typical for a biopsy exam, as well as flow cytometry phenotyping, cytogenetics for chromosomal analysis, and possibly additional immunohistochemistry tests.

The idea of a lymphoma protocol is an accepted industry standard that involves a level of work more equivalent to an 88307 specimen, such as sentinel lymph node biopsy, than an 88305 lymph node biopsy.

Beware: Despite the evidence for billing 88307 for a lymphoma workup, some experts caution that you should stick with 88305 unless you have a greenlight from your payer to use 88307 in carefully documented cases.