Pathology/Lab Coding Alert

Question: Our pathologist examined a colon resection for tumor and diagnosed metastatic ovarian carcinoma of the bowel. The pathologist claims that we should bill this as 88307 because it does not require the same amount of work as a primary colon neoplasm. Is this correct?

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Answer: No, your pathologist's advice is not correct. You should report surgical pathology specimens such as a colon resection based on the specimen lists that CPT provides under each code (88302-88309).

CMS prices the codes based on the amount of work involved in processing the average specimen. Sometimes a specimen will require more work than normal, and sometimes less, but you should always bill according to the specimen list.
 
Exception: If your pathologist examines a specimen that is not listed under codes 88302-88309, you should select the appropriate code based on the amount of work involved in diagnosing the specimen relative to other specimens listed under that code. The "amount-of-work" criterion only applies to unlisted specimens.
 
Do this: In the case you describe, you should code the service as CPT 88309 (Level VI - Surgical pathology, gross and microscopic examination, colon, segmental resection for tumor). This is the proper code whether the tumor is primary or a secondary metastatic tumor. In fact, if the pathologist processes the colon resection based on the surgeon's identification of suspected tumor, you should report 88309 even if the final diagnosis is non-neoplastic.