Pathology/Lab Coding Alert

Question: When our pathologists examine placentas submitted due to cesarean or other abnormal delivery, we report the procedure as CPT 88307 . Which diagnosis code should we use when the placenta is normal? Utah Subscriber Answer: CPT provides two procedure codes for examination of placenta depending on the gestational stage: 88305 (Level IV Surgical pathology, gross and microscopic examination, placenta, other than third trimester) and 88307 (Level V Surgical pathology, gross and microscopic examination, placenta, third trimester). Although most placentas you receive will probably be 88307, be aware that you must report 88305 if the patient delivers prior to 28 weeks gestational age.

You should assign the diagnosis for a normal placenta based on the reason for the exam. The ordering physician should explain the delivery conditions that indicated the need for the placenta examination. If the exam is due to cesarean delivery with no other condition indicated, report 669.71 (Cesarean delivery, without mention of indication, delivered, with or without mention of antepartum condition). You may receive a placenta specimen for many of the diagnoses listed in ICD-9 chapter 11, "Complications of pregnancy, childbirth and the puerperium."

Many of these codes require reporting to the subclassification level, such as fifth digits 0-4 for codes 670-677 that refer to the current episode of care, such as antepartum, delivered or postpartum status. For example, if you receive a retained placenta, report 667.0x (Retained placenta without hemorrhage) to the fifth digit. ICD-9 lists in brackets under each of these four-digit codes the possible fifth digits that are valid for that code. For instance, you can only list 667.0 with fifth digit 0 (Unspecified as to episode of care or not applicable), 2 (Delivered, with mention of postpartum complication) or 4 (Postpartum condition or complication).