Pathology/Lab Coding Alert

The addition of sentinel lymph node to the specimen list for CPT 88307 (level V surgical pathology, gross and microscopic examination; sentinel lymph node) in CPT 2001 has made coding and reimbursement for sentinel lymph node biopsy easier. Fast becoming a standard of care for some cancers, the procedure should be reported with 88307, in addition to other codes that describe processing of the biopsy tissue, such as special stains. To capture appropriate reimbursement for a sentinel lymph node biopsy, pathology coders need to be familiar with the components of the procedure and the unit of service for each part.

Although the addition of sentinel lymph node to the 88307 specimen list is a step in the right direction, it does not fully account for the process involved, says Lena Spencer, MA, HTL (ASCP), HT, QIHC, a histotechnologist at Norton Healthcare in Louisville, Ky.

Melanoma: A Clinical Example

Increasingly, physicians use sentinel lymph node biopsy to detect the spread of melanoma (skin cancer) or breast or other cancers, says Matthew McCoy, MD, director of anatomic pathology at Methodist Hospital, a part of Park Nicollet Group in St. Louis Park, Minn.

A patient presenting with a suspicious mole of the skin (238.2) would first undergo a punch biopsy or small excisional biopsy at the physicians office. The pathologist receives the specimen for diagnosis, reporting the procedure as 88305 (level IV surgical pathology, gross and microscopic examination, skin, other than cyst/tag/debridement/plastic repair). The physician schedules a followup surgery using the pathology results. For a patient with invasive melanoma of Clarks level two to level five with non-palpable lymph nodes, for example, the surgeon may conduct a sentinel lymph node biopsy and wide excision.

The sentinel lymph node biopsy is conducted at the time of wide excision of the lesion. According to McCoy, the cancer site is injected with a radioisotope called technetium 99. This preoperative lympho-scintigraphy allows the radiologist to assess lymphatic drainage from the lesion. The now-radioactive sentinel node is identified using a hand-held gamma detector, and the location is marked for the surgeon. The code for this procedure is 78195 (lymphatics and lymph glands imaging).

The cancer site is then injected with isosulfan blue dye to further assist the surgeon in locating the sentinel node, McCoy says. Code 38792 (injection procedure; for identification of sentinel node) is used to report this service. The surgeon excises the sentinel node or nodes for analysis by the pathologist. Depending on the location of the lesion, we may receive nodes from two different drainage basins, he says.

The pathologist receives the sentinel node and carries out the gross and microscopic examination for a lymph node biopsy, which is coded 88307. If [...]