Pathology/Lab Coding Alert

Hint: Capture separate specimens to boost your bottom line

If your pathologist examines a complicated endometrial cancer case, you might find yourself underreporting or running afoul of bundling rules.

Read the following case description, then see what steps our experts recommend to help you tackle three coding challenges it presents. First, Read Over This Case Note Diagnosis: Adenocarcinoma of the endometrium with metastatic involvement of omentum.

Operation performed: Hysterectomy with bilateral salpingo-oophorectomy, pelvic and periaortic node dissection, partial omentectomy.

Procedure: The surgeon removed the uterus with fallopian tubes and ovaries, and the pathologist was present to open the organ and render an opinion.

The pathologist reported an enlarged, fungating, relatively superficial lesion of the endometrium. Up in the patient's right fundal area, however, the pathologist noted an invasion of the myometrium at least two-thirds of the way through. He examined two frozen section blocks from the fundus. Based on the pathologist's observations, the surgeon performed a partial omentectomy and bilateral pelvic (iliac) node dissection. The surgeon also obtained tissue in the periaortic lymphatic chain area, and the pathologist examined a frozen section from one of the lymph nodes. Coding Challenge 1: Capture Intraoperative Service The first thing you must do is decide what to charge for the pathologist's intraoperative service. When you read the description, notice that the pathologist provides a consultation based on gross examination, and also examines three frozen section blocks. Hint: Watch out for Correct Coding Initiative (CCI) edits when you select the code(s), says R.M. Stainton Jr., MD, president of Doctors- Anatomic Pathology Services in Jonesboro, Ark.

Answer: The pathologist performs intraoperative frozen sections. For the first block from the fundus, you should report 88331 (Pathology consultation during surgery; first tissue block, with frozen section[s], single specimen) and the second slide as 88332 (- each additional tissue block with frozen section[s]). For the frozen section from the lymph node, you should report an additional unit of 88331, Stainton says. 

Avoid this pitfall: Although the pathologist provides a consultation based on gross exam of the specimen, you should not additionally report 88329 (Pathology consultation during surgery). CCI edits bundle 88329 with 88331 and 88332 because the frozen sections include the consultation service. Coding Challenge 2: Define Separate Specimens The pathologist examines the uterus, omentum, and fallopian tubes and ovaries (and lymph nodes, but we-ll look at those in challenge 3). Hint: You must consider bundling rules as you identify which tissues constitute separate specimens. -You also have to consider that the adenocarcinoma diagnosis will impact your code selection for uterus,- Stainton says.

Answer: The op report lists hysterectomy and bilateral salpingo-oophorectomy en bloc, so you can't report them as separate specimens. CPT bundles tubes and ovaries with the uterus in an instance [...]