Pulmonology Coding Alert

Question: If the pathologist examines a lung specimen that the surgeon identifies as a lung wedge resection, what code should we report? The “biopsy” vs. “resection” terminology has us confused.

Maine Subscriber

Answer: The terminology difference, which can be confusing, stems from the fact that the CPT® surgery section refers to a lung wedge specimen as a “resection” while the pathology section refers to the same specimen as a “biopsy” Look at these codes to see the terminology difference:

• 32505 (Thoracotomy; with therapeutic wedge resection (e.g., mass, nodule), initial)
• <!--[if !supportLists]--> +32506 (Thoracotomy; with therapeutic wedge resection (e.g., mass or nodule), each additional resection, ipsilateral (List separately in addition to code for primary procedure).

The above codes speak of the surgical procedure of removal of a lung portion for therapeutic purposes.

The pathology section includes a code for a wedge biopsy of the lung and a lung resection:

• 88307 (Level V — Surgical pathology, gross and microscopic examination, … lung, wedge biopsy …)
• 88309 (Level VI — Surgical pathology, gross and microscopic examination, …lung — total/lobe/segment resection …).

Key: First, know whether you are reporting the therapeutic thoracotomy surgical procedure (33505 and 33506) or only the process of examination of received surgical specimens (the pathology codes). From there, look for the term “wedge” to determine that the specimen warrants 88307, regardless of whether the surgical report uses the term “resection.” You will generally find that the surgeon reports the procedure as “wedge resection of lung.”

Diagnosis irrelevant: Although the surgeon typically reserves wedge resections for lesions that he expects to be benign, the specimen may turn out to be cancerous. Regardless of the final diagnosis, the pathologist should not upcode a lung wedge specimen to 88309.

Understand biopsy: Don’t let the “biopsy” terminology confuse you either. CPT® lists lung biopsies other than a “wedge” as an 88305 service (Level IV — Surgical pathology, gross and microscopic examination, …lung, transbronchial biopsy…). The pathologist will use 88307 for wedge specimens to accurately capture your physician’s level of service.

The surgeon will only report the procedure (i.e., surgery), the pathologist will report the specimen analysis. In order to determine which code to report for the procedure, do not rely on the specimen identification in the pathology report, but rather the details of the procedure report.