Pathology/Lab Coding Alert

Question: We have a case that the pathology report identifies as a “right hepatic wedge resection” specimen and a “four periportal lymph nodes” specimen. What is the correct procedure code(s), and should we bundle the lymph nodes?

Kentucky Subscriber

Answer: You should separately report the liver wedge resection as 88307 (Level V - Surgical pathology, gross and microscopic examination … Liver, biopsy - needle/wedge … or Liver, partial resection) and the regional lymph node resection as an additional unit of 88307 (… Lymph nodes, regional resection). 

Because 88307 includes a listed specimen for liver to include “biopsy – needle/wedge” and “partial resection,” the distinction about whether the liver specimen in this case is a partial resection or a wedge biopsy doesn’t impact your code choice.

Document: You state that the report identifies the lymph nodes as a distinct specimen, so if the documentation supports a separately-submitted, separately-diagnosed lymph node resection, this case warrants an additional 88307 for the lymph nodes.

Caution: Although the CPT^® definition of either liver specimen doesn’t specifically state that you must bundle lymph nodes (as some listed specimens do), coding convention suggests that you should not separately report lymph nodes attached to a liver resection specimen. Attached nodes are more common in a partial anatomic resection, possibly including hepatic, cystic, or phrenic nodes.