Pathology/Lab Coding Alert

Question: The surgeon submits a sigmoid colon resection and mesenteric lymph nodes for tumor evaluation. The pathologist examines the specimen, including margin evaluation, and also examines the lymph nodes. The pathologist diagnoses a non-neoplastic condition. How should we code the pathologist's work?

Iowa Subscriber  Answer: You should not use the final diagnosis to determine the code selection for colon resection specimens. The two code choices are 88307 (Level V -- surgical pathology, gross and microscopic examination, colon, segmental resection, other than for tumor) and 88309 (Level VI -- surgical pathology, gross and microscopic examination, colon, segmental resection for tumor).
 
Because the definitions distinguish the specimens based on whether the resection is -for tumor,- you need to understand that the designation does not refer to a cancer diagnosis. If the pathologist processes the specimen as though it is cancerous based on preliminary clinical findings -- including margin evaluation, for instance -- you should report 88309 regardless of clinical findings. That's why your case warrants 88309 rather than 88307.
 
Because mesenteric lymph nodes are typically integral to a colectomy specimen, you should not separately report the pathologist's examination of lymph nodes as either 88305 (Level IV -- Surgical pathology, gross and microscopic examination, lymph node, biopsy) or 88307 (- lymph nodes, regional resection). You should consider the lymph nodes bundled with the colon resection and their examination part of the pathologist's 88309 service in this case.