Pathology/Lab Coding Alert

Question: Our pathologist received a partial pancreatectomy for diagnosis. The surgeon had inked a large piece of omentum that was in the container and mentioned it in the note. The pathologist processed the pancreas and omentum as separate specimens, diagnosing pancreatic cancer and omentum necrosis and abscess. How should we code the case?

Nebraska Subscriber

Answer: Assuming your pathologist adequately documents processing, examining, and diagnosing the pancreas and omentum as separate specimens, you should be able to bill the work as 88309 (Level VI - Surgical pathology, gross and microscopic examination… Pancreas, total/subtotal resection …) for the partial pancreatectomy, and 88305 (Level IV - Surgical pathology, gross and microscopic examination… Omentum, biopsy…) for the omentum.

Caution: A pancreatectomy specimen often includes an attached or separate band of omentum as a surgical margin, which would not warrant reporting a separate 88305 in addition to the pancreatectomy 88309.

Key: Reporting two separate procedures is justified in this case because the surgeon separately identified the omentum, and the pathologist separately examined and diagnosed the tissue.

Dx: Without further indication about what part of the pancreas the pathologist examined, you should report the pancreas diagnosis as C25.9 (Malignant neoplasm of pancreas, unspecified). ICD-10-CM provides more specific codes for pancreatic cancer based on anatomic site, such as pancreas head (C25.0), body (C25.1), tail (C25.2) duct (C25.3), etc. For the abscessed omentum specimen, report K65.1 (Peritoneal abscess), which notes “Abscess (of) omentum” as an inclusion term.