Pathology/Lab Coding Alert

Question: The pathologist examines eight pieces of tissue submitted from a TURP, labeled A-H. Samples E and F show adenocarcinoma, but all others have no evidence of cancer. Since this is a partial prostate resection, should we report CPT 88307 (Level V - surgical pathology; prostate, except radical resection) or 88305 (Level IV - surgical pathology; prostate, TUR)? If we use 88305, should we report the code once for each piece of tissue submitted? Also, what is the correct diagnosis code for this case?  

Iowa Subscriber

Answer: Transurethral resection of prostate (TURP) coding is confusing, because as you pointed out, two codes potentially describe the service. CPT lists partial prostate resection as 88307, but CPT also lists a distinct code for TURP (88305) even though TURP is a type of partial prostate resection. 

The transurethral surgical approach means that the surgeon typically submits the prostate resection in multiple, small pieces, as you described in your case. An open partial prostate resection, on the other hand, typically involves just one or two larger pieces of prostate tissue.

Pathologists often find the TURP specimen to be more work than examining the tissue from an open partial prostatectomy. Even so, you should report the service as 88305 because it is the most exact CPT code for the service. And even though the pathologist may receive many individual pieces of tissue, you should report one unit of 88305, regardless of the number of blocks.

Assign the ICD-9 code based on the pathologist's findings rather than the ordering physician's initial diagnosis, because the pathologist's diagnosis is more specific. Because the TURP showed adenocarcinoma, you should code the cancer even though the pathologist did not find cancer in each block. The proper ICD-9 code is 185 (Malignant neoplasm of prostate).