Pathology/Lab Coding Alert

Question: How should I code an excisional breast biopsy (lumpectomy) when both the lesion and margins are evaluated based on a previous biopsy showing abnormal cell changes, but the final pathology report is benign? Would the proper code be 88305 because of the benign diagnosis, or 88307 because of the margin evaluation?

Colorado Subscriber
 
 Answer: Breast tissue is assigned to three levels of surgical pathology based on the extent of the physician work involved in the evaluation, not the diagnosis. The codes are 88305 (level IV - surgical pathology, gross and microscopic examination; breast biopsy, not requiring microscopic evaluation of surgical margins), 88307 (level V - surgical pathology, gross and microscopic examination; breast, excision of lesion, requiring microscopic evaluation of surgical margins or breast, mastectomy - partial/simple) and 88309 (level VI - surgical pathology, gross and microscopic examination; breast, mastectomy - with regional lymph nodes). 
 
The lumpectomy specimen involves pathology evaluation of the entire lesion and surgical margins. The proper code is 88307 regardless of the final diagnosis. However, the terminology excisional breast biopsy is misleading. If the physician orders the excision of the lesion based on patient history and evaluation of prior biopsy, the procedure should more accurately be described as excision of lesion. This would involve evaluation of the margins to determine if they are free of disease. The evaluation of the specimen, including margins, is the same.