Pathology/Lab Coding Alert

Question: Our pathologists often perform EGFR, KRAS, and BRAF molecular analyses. In addition to the molecular codes, we've been billing 88305 for evaluating the specimen to select tissue for the test. Someone has suggested that we should bill 88381 instead, since the primary pathologist has already examined these specimens. Which option is correct?

Tennessee Subscriber

Answer: When your pathologist receives a previously diagnosed specimen and examines the tissue to select portions for molecular analysis, you should not charge 88305 (Level IV - Surgical pathology, gross and microscopic examination ...). Reserve that code for the initial pathology examination and diagnosis, which your pathologist does not perform, in the scenario you describe.

Select one: Instead, you should select one of the following codes, depending on the process the pathologist uses to examine and select tissue for molecular pathology testing such as EGFR, KRAS, and BRAF:

• 88363 -- Examination and selection of retrieved archival (i.e., previously diagnosed) tissue(s) for molecular analysis (e.g., KRAS mutational analysis)
• 88380 -- Microdissection (i.e., sample preparation of microscopically identified target); laser capture
• 88381 -- ... manual.

If the pathologist examines and selects archival tissue for a molecular test, report 88363. If the pathologist performs microdissection to prepare the sample for molecular pathology testing, either manually or using laser capture technique you should choose either 88381 or 88380.

Watch edits: Correct Coding Initiative (CCI) bundles 88363 with 88380 and 88381. Select only the most extensive procedure your pathologist uses in the tissue prep for molecular testing, which would be microdissection, if performed.

Macroscopic unlikely: Although CPT® provides the following codes to capture a pathologist's work preparing tissue for molecular studies, these codes don't apply to the scenario in your question:

• 88387 -- Macroscopic examination, dissection, and preparation of tissue for nonmicroscopic analytical studies (e.g., nucleic acid-based molecular studies); each tissue preparation (e.g., a single lymph node)
• +88388 -- ... in conjunction with a touch imprint, intraoperative consultation, or frozen section, each tissue preparation (e.g., a single lymph node) (List separately in addition to code for primary procedure).

When preparing a specimen for molecular studies, 88387 and +88388 refer to specific pathologist macroscopic work that takes place before the pathologist performs the microscopic examination (such as 88305). In contrast, 88363 takes place on archival tissue after the pathologist has completed the surgical pathology service and signed out the case. The latter code more closely matches the situation you described in your question.