Pathology/Lab Coding Alert

Question: Our pathologist received two containers, one marked “skin lesion, right upper thigh” and one marked “inguinal sentinel lymph node.” Upon examination, the pathologist noted two lymph nodes in the container marked “inguinal sentinel lymph node.” How should we code this?

Texas Subscriber

Answer: The correct coding for this case is 88305 (Level IV - Surgical pathology, gross and microscopic examination… Skin, other than cyst/tag/debridement/plastic repair …) for the skin specimen exam and 88307 (Level V - Surgical pathology, gross and microscopic examination … Sentinel lymph node …) for the sentinel lymph node exam.

Singular: A question you may have is whether to report two units of 88307 because the case involves two sentinel nodes, and the code for sentinel lymph node is singular. The answer is that you should not code two units for this case based on the documentation provided.

Remember that the CPT^® instruction for surgical pathology codes defines a specimen as “tissue or tissues that is (are) submitted for individual and separate attention, requiring individual examination and pathologic diagnosis.”

Documentation: The surgeon submitted the two nodes together without distinction and identified the specimen as “inguinal sentinel lymph node.” If the surgeon had distinguished the nodes in some way such as inking or a note, and the pathologist separately processed and diagnosed the two nodes, you could report two units of 88307. You may also report two units of 88307 if the pathologist distinguishes the nodes and documents separately processing and examining each node with different findings, such as cancer cells in one node and normal cells in the other.

Sentinel lymph node exams are time consuming, involving serial sectioning and staining for evaluation in great detail. The pathologist in this case had to examine both nodes. The 88307 pay is $290.69 (2022 Medicare Physician Fee Schedule national facility amount, conversion factor 34.6032). Pathology practices could benefit by communicating the payment impact of documentation to pathologists and physician clients alike.