Wiki Co-mingled Specimens

[ohdl1977]

We received the following specimen(s) in connection with a Pancreatectomy case. Our question is specific to the specimen that contained the spleen with lymph nodes. Can the lymph nodes and the spleen be billed separately (e.g. spleen 88305 and lymph nodes as an 88307).

D. "Spleen":
- Spleen with red pulp congestion, 265 g.
- Nine (9) reactive splenic hilar lymph nodes.
- No malignancy seen.

Gross Description:
D. The specimen is received in formalin labeled with the patient's name and "spleen". The specimen consists of a 265g splenectomy specimen measuring 13.5 x 9.5 x 4.5 cm. The capsule is gray/purple and grossly intact.
Sectioning reveals a red-tan homogeneous cut surface with no gross masses or nodules. Eight pink-tan possible lymph nodes are identified in the hilar fat ranging in size from 0.4 to 1.2 cm in greatest dimension. The specimen is representatively submitted as follows:
Cassette D1: Vascular resection margin
Cassette D2: Representative from spleen
Cassette D3: Three possible lymph nodes
Cassette D4: Five possible lymph nodes

Thanks,
Denise Leid CPC
Coding Specialist
Phone 941-362-8900
Fax 941-362-8933
dleid@sarapath.com

 

[KathyJohnson]

Since it's not the norm for the lymph nodes to be removed as part of a splenectomy you would code for the lymph nodes separately.

 

[atipton12]

In my opinion, I would not bill separately for the lymph nodes that were found in the hilar fat on the resected spleen, even though several were identified. According to the documentation you provided, it does not appear to me that the surgeon "purposely" meant to take the lymph nodes with the spleen, but that they were "coincidentally" taken, thus not qualifying to bill as a separate lymph node resection.

Again, only my opinion. If the surgeon has submitted the specimen labeled "spleen with lymph nodes" I would then most likely be inclined to bill separately for them with the belief that the surgeon intended for the pathologist to examine them.