Pathology/Lab Coding Alert

Question: What code should we use for the pathology exam of the following specimen: "ethmoid: 0.3 x 0.3 x 0.2 cm bony tissue with overlying soft tissue." The clinical diagnosis is deviated nasal septum with hypertrophic turbinate.


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Answer: Ethmoid tissue is not a listed specimen in the CPT surgical pathology codes. CPT's direction for these codes 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." That means you'll have to assign the code yourself based on the pathologist's work for comparable specimens.

Most pathologists consider 88304 (Level III - Surgical pathology, gross and microscopic examination) the appropriate level for any specimen that is essentially a debridement of the nasal cavity with no neoplasm. That would include ethmoid, turbinate and nasal septum. The most comparable listed specimen is 88304 (... Polyps, inflammatory - nasal/sinusoidal).
 
Although CPT lists a nasal specimen under 88305 (Level IV - Surgical pathology, gross and microscopic examination, nasal mucosa, biopsy), this specimen is not comparable to ethmoid tissue removed for deviated nasal septum. You should use the 88305 nasal biopsy code for suspected neoplastic specimens.

Because the ethmoid is bony tissue, the lab probably performs a decalcification before the pathologist examines the slides. Don't forget to report +88311 (Decalcification procedure [list separately in addition to code for surgical pathology examination]) in addition to 88304 if the lab performs the decalcification service. Reader Questions and You Be the Coder were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark.