Pathology/Lab Coding Alert

Question: What is the correct code for evaluation of a capsule surrounding a breast implant? Some feel that the code should be 88305 because the only CPT code for benign breast is 88305 and/or because of the medico-legal aspect. Others feel that the difficulty level is much less than a true breast biopsy and 88304 should be the code.

Sarah Webb, MD

Answer: This type of problem comes up a lot. What do you do when the specimen is not listed in the CPT book? CPT 2000 gives direction for specimens that are not listed under any of the surgical pathology codes 88302-88309. It states: Any unlisted specimen should be assigned to the code which most closely reflects the physician work involved when compared to other specimens assigned to that code. The fact that this specimen comes from the breast is irrelevant to the code selection. When dealing with unlisted specimens, the code should be selected based on the level of work involved rather than the origin of the specimen. Therefore, if the work involved in this evaluation is the level of 88304, use that code.