Pathology/Lab Coding Alert

Question: Our pathologist evaluated a frozen section of a lung wedge biopsy during surgery, and later processed the biopsy specimen. Based on the pathologist’s frozen section findings, the surgeon proceeded with a lung lobe resection, and our pathologist consulted on the margins of this specimen, preparing three blocks for frozen sections and reporting to the surgeon that the margins were clear. The pathologist also processed and evaluated the lung resection specimen. How should we code the case?

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Answer: Complete coding for this case includes 88331 x 2 (Pathology consultation during surgery; first tissue block, with frozen section[s], single specimen), 88332 x 2 (… each additional tissue block with frozen section[s] [List separately in addition to code for primary procedure]), 88307 (Level V - Surgical pathology, gross and microscopic examination…, Lung, wedge biopsy), and 88309 (Level VI - Surgical pathology, gross and microscopic examination…, Lung - total/lobe/segment resection).

Frozen sections: Because the pathologist intraoperatively examines a frozen “first tissue block” from two separate lung specimens — the wedge biopsy and the lobe resection — you’ll bill two units of 88331. Depending on the payer, you may need to append modifier 59 (Distinct procedural service) or other appropriate modifier to indicate that these are from two different specimens.

For the lobe resection, the pathologist intraoperatively examined two additional frozen section blocks after the first that you billed as 88331, and you should report the additional two blocks as 88332 x 2.

You should bill 88307 for the wedge biopsy, and 88309 for the lung resection, which the pathologist receives, examines, and evaluates as two distinct specimens.