Pathology/Lab Coding Alert

Question: Our pathologist examined a cecum with attached appendix and a separate gallbladder. Which of these specimens warrants separate codes?

Tennessee Subscriber

Answer: In almost all circumstances, you should bundle the appendix with the cecum as a partial colon-resection specimen.

Select the correct code for the colon segment specimen based on whether the resection is for a tumor or some other reason. The two codes are as follows:

- 88307-- Level V " Surgical pathology, gross and microscopic examination, colon, segmental resection, other than for tumor

- 88309 -- Level VI " Surgical pathology, gross and microscopic examination, colon, segmental resection for tumor.

Although CPT provides two codes for appendix as a specimen (88302, Level II " Surgical pathology, gross and microscopic examination; appendix, incidental) and 88304 (Level III " Surgical pathology, gross and microscopic examination; appendix, other than incidental), you would not commonly report either code for an appendix attached to the cecum because the appendix is an integral part of the colon resection specimen that is not diagnostically significant.

Exceptions: If the surgeon distinctly identifies the appendix for separate examination, such as by suturing and/or distinctly requesting appendix exam in the requisition, you can separately report the appendix. You-ll rarely see this circumstance, and if you do, it is probably because the surgeon notes an abnormality that would indicate that the appendix is not incidental -- so you-d expect an 88304 charge as opposed to 88302.

If the surgeon doesn't separately identify the appendix, but the pathologist reports significant, distinct pathology apart from the colon diagnosis, you should report an additional 88304 for the appendix.

Gallbladder is different: The gallbladder is not a common, attached tissue that is part of a colon resection. You should code the gallbladder as a separate specimen using 88304 (- gallbladder).