Pathology/Lab Coding Alert

Pathologists aren't the only ones who have to separate tissues submitted from major surgical procedures coders do too. When the surgeon sends a radical cystectomy en bloc, you should code the case based on the individual specimens examined by the pathologist.

"Regardless of how the surgeon submits the tissue, you should report the pathologist's work based on the CPT Codes specimen definitions and adjunct services provided, such as frozen sections or special stains," says R.M. Stainton Jr., MD, president of Doctor's Anatomic Pathology, an independent pathology laboratory in Jonesboro, Ark. CPT defines a surgical pathology specimen as "tissue or tissues that is (are) submitted for individual and separate attention, requiring individual examination and pathologic diagnosis," and lists about 180 individual specimens under surgical pathology codes 88302-88309. Case Study Exemplifies Coding Strategy Not all radical cystectomies are created equal surgeons remove different tissues based on the particular patient and condition. Use the following case as an example of how to code these complex surgical procedures:

The radical cystectomy consisted of a bladder and attached left and right distal ureter segments with adhering prostate. The surgeon also submitted in separate jars four left obturator lymph nodes and three right obturator lymph nodes. The pathologist reports the following:
Bladder examination poorly differentiated transitional cell carcinoma
Prostate examination glandular hyperplasia and necrotizing granulomatous inflammation, negative for acid fast and fungal stains
Left distal ureter margin examination one frozen section and ureter examination negative for tumor
Right distal ureter margin examination two frozen sections from one block and ureter examination negative for tumor
Left obturator regional lymph node resection two frozen sections from each of two blocks and examination of nodes negative for tumor
Right obturator regional lymph node resection frozen section and examination of nodes negative for tumor.   Assign Codes by Specimen,Service "Although surgeons often remove the prostate in a radical cystectomy, it is a separate, listed specimen requiring individual examination and diagnosis, so you should code it as such," Stainton says. Code services for the bladder and prostate as follows:
Bladder 88309 (Level VI Surgical pathology, gross and microscopic examination, urinary bladder, partial/total resection)
Prostate 88307 (Level V Surgical pathology, gross and microscopic examination, prostate, except radical resection)

"This prostate specimen is similar to an open prosta-tectomy rather than a radical prostatectomy for tumor, so the appropriate code is 88307 rather than 88309," Stainton says.
Acid fast bacillus stain and fungal stain for prostate histopathology Report two units of +88312 (Special stains [list separately in addition to code for surgical pathology examination]; Group I for microorganisms [e.g., [...]