Pathology/Lab Coding Alert

Question: The surgeon submitted a hysterectomy in three separate containers identified as follows: A) right tube and ovary, B) uterus and cervix, C), left tube and ovary. The pathologist diagnosed A) as a serous cystadenoma, B) as a leiomyoma, and C) as an incidental tube and ovary. How should we code?California SubscriberAnswer: You should report the service as two units of 88307 (Level V - Surgical pathology, gross and microscopic examination, ovary with or without tube, neoplastic). Based on the tissue submitted and the pathologist's diagnoses, here's the breakdown for your code selection:A) Right ovary with tube, serous cystadenoma. Report 88307, because the ovary involves a primary ovarian cancer that demonstrates distinct pathology from the uterus specimen. Although you should typically bundle ovaries with a hysterectomy specimen, you can separately code an ovary when the pathologist documents distinct pathology.B) Uterus and cervix, leiomyoma. Report 88307 (... uterus, with or without [...]