Take This Advice to Select the Correct Tonsil Biopsy Code
Question: Can you explain the difference between 88304, 88305, and 88309 with regard to tonsil specimen biopsies? When would you use each of these codes? Georgia Subscriber Answer: The three anatomic pathology exam codes for tonsil specimens are, as you say: Essentially, you would use 88304 when your lab obtains the specimen from a tonsillectomy procedure that the surgeon performs for a reason other than suspected cancer, such as tonsillitis. Code 88305 comes into play when the surgeon suspects the tonsil may be cancerous, while you would use 88309 when the surgeon obtains the specimen during a resection, which is where the surgeon attempts to excise an entire lesion that is suspected of being cancerous — a larger and more complex procedure. Remember: Code 88304 describes a single tonsil specimen with or without associated adenoid tissue. That means if the pathologist receives two separately identified tonsils, with or without adenoids, you may report 2 units of 88304. But if the surgeon submits all the tissue in one container with no distinction of left and right tonsil, you must select just 1 unit of 88304 for the case. That’s true even if the specimen includes adenoids. Even so, you should never unbundle adenoids from a tonsil specimen. Report one tonsil with or without adenoids as 88304, or just adenoids as 88304. Confusingly, the tonsil and/or adenoids specimen referred to in 88304 may well involve more tissue than the higher-level tonsil biopsy described by 88305. Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC
