Pathology/Lab Coding Alert

Question: Our pathologist consulted during surgery for a lesion excision case involving frozen sections for three lesions. I say we should code 88331 and 88332 x 2, but my pathologist claims we should use 88331 x 3. Who is right?

Oregon Subscriber

Answer: Your pathologist is right, assuming that the pathology report truly documents three separate lesions.

Here's why: For a frozen section consult on the first tissue block from a unique specimen, you should code 88331 (Pathology consultation during surgery; first tissue block, with frozen section[s], single specimen). You should only list 88332 (... each additional tissue block with frozen section[s]) if the pathologist prepares and examines frozen sections from additional blocks from the same specimen.

You indicate that the surgeon excised and the pathologist examined three distinct lesions. If the pathology report documents frozen sections from three unique lesions, each lesion warrants the code for "first tissue block" -- 88331.

Avoid the $49 mistake: If you report 88332 when circumstances justify reporting 88331, you stand to lose $49 (based on the Physician Fee Schedule National facility amount using conversion factor 36.0846). In this example, downcoding two frozen section exams amounts to $98 that your pathologist actually deserves.