Pathology/Lab Coding Alert

Question: Will the new surgery codes for myomectomy and hysterectomy (58146, 58545-58554 and 58290-58294) impact coding for these surgical pathology specimens? Virginia Subscriber Answer: The new CPT 2003 codes you mention will not impact surgical pathology coding for these specimens, but they may impact the information needed in the pathology report. The new vaginal hysterectomy codes (58290-58294), open myomectomy code (58146), and laparoscopic myomectomy with or without vaginal hysterectomy codes (58545-58554) require information regarding specimen mass for proper code assignment.

"When pathologists look at fibroid specimens, they must now report specimen weight so the surgeon can apply the proper procedure code," says Laurie Castillo, MA, CPC, CPC-H, CCS-P, member of the National Advisory Board of the American Academy of Professional Coders and president of Physician Coding and Compliance Consulting in Virginia. "The irony is that this information has no impact on the pathology code selection."

Continue to report pathology examination of fibroid hysterectomy specimens as 88307 (Level V Surgical pathology, gross and microscopic examination, uterus, with or without tubes and ovaries, other than neoplastic/prolapse). Although ICD-9 classifies leiomyoma as a neoplasm, based on convention established by the College of American Pathologists and CMS, do not report a fibroid hysterectomy as 88309 (Level VI uterus, with or without tubes and ovaries, neoplastic). Note that although the removal of tubes and/or ovaries impacts the surgical code selection (58290, Vaginal hysterectomy, for uterus greater than 250 grams; and 58291, with removal of tube[s] and/or ovary[s]), it does not impact the pathology code selection because 88307 states "with or without tubes and ovaries."

Continue to report pathologist evaluation of myomectomy specimens as 88305 (Level IV Surgical pathology, gross and microscopic examination, leiomyoma[s], uterine myomectomy without uterus), regardless of specimen size. Number or weight of myomas only impacts the new surgical codes, e.g., 58545, Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight of 250 grams or less and/or removal of surface myomas; and 58546, 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 grams. Surgeons must now wait for the pathology report, including the specimen mass information, before coding the surgery.