Pulmonology Coding Alert

Question: Our pathologist receives a lung wedge biopsy for immediate diagnosis. The pathologist examines the specimen and prepares three frozen sections to provide an intraoperative diagnosis.

Based on the diagnosis, the pulmonologist proceeds with a lobe resection, and the pathologist consults to ensure the margins are clear. The pathologist selects portions of the margins, resulting in three blocks for frozen sections, and then evaluates the wedge biopsy and the lung resection. How should we report  these services?

Arkansas Subscriber

 
Answer: You should report the evaluation of the lung biopsy with code 88307 (Level V - Surgical pathology, gross and microscopic examination, lung, wedge biopsy). You should then report the examination of the lung resection as 88309 (Level VI - surgical pathology, gross and microscopic examination, lung - total/lobe/segment resection).

You should bill for the intraoperative consultations as follows: 88331 (Pathology consultation during surgery; first tissue block, with frozen section[s], single specimen) for the first consultation on the biopsy that included three frozen sections.

You should then report code 88331 (...first tissue block; with frozen section[s], single specimen) once for the first block from the lobe resection evaluated for margin involvement, and 88332 (Pathology consultation during surgery; each additional tissue block with frozen section[s]) reported twice: once for each of the additional blocks from the lung resection evaluated for margin involvement.

Because this scenario involves multiple specimens from the same patient on the same day, you should append modifier -59 (Distinct procedural service) to clarify that each service is separate and that a single specimen is not being unbundled.

In this case, since the physician completed the wedge biopsy and the lobe resection as separate excisions and represent separate specimens, you should report each service individually.

Don't miss: Because the two units of 88331 represent separate specimens (and separate patient encounters), you should report them separately as well.