Pathology/Lab Coding Alert

Downcoding and bundling can cost you cash

When your pathologist examines a stomach resection with associated tissue--like peritoneum, lymph nodes or spleen--you could be missing out on potential pay.
 
A surgeon might remove multiple organs or portions of organs, leaving pathology coders to struggle with what constitutes an individual specimen. “Complex surgical specimens are especially susceptible to either underreporting or bundling errors,” says R.M. Stainton Jr., MD, president of Doctors’ Anatomic Pathology Services, an independent pathology laboratory in Jonesboro, Ark.

To help you avoid these pitfalls for gastrectomy coding, just answer these three questions to ensure rightful compensation for your services: 1. Is the stomach removed for cancer? CPT lists two codes for partial or total stomach resection: 88307 (Level V--Surgical pathology, gross and microscopic examination, stomach--subtotal/total resection, other than for tumor) and 88309 (Level VI--Surgical pathology, gross and microscopic examination, stomach--subtotal/total resection for tumor).

Key: “The difference between the two codes is whether the resection is for tumor or any other reason,” says Pamela Younes, MHS, HTL (ASCP), CPC, PA (ASCP), assistant professor at Baylor College of Medicine in Houston. That means you need to know the final diagnosis, which you should find in the pathologist’s report. Generally, you will report 88307 or 88309 based on whether the resection specimen is a neoplasm.

For instance: If the pathologist diagnoses adenocarcinoma (151.x, Malignant neoplasm of stomach), you should report the stomach resection specimen as 88309. But if the pathologist examines a normal partial gastrectomy from a bariatric surgery such as 43845 (Gastric restrictive procedure with partial gastrectomy ...), you should list the pathologist’s work as 88307.

Opportunity: Even if the pathologist does not find cancer in the current stomach resection, you may be able to report the specimen exam as 88309. “If the patient has a confirmed cancer diagnosis from a prior stomach biopsy, you should report the pathologist’s work for the stomach resection as 88309 regardless of the final diagnosis,” Younes says. That’s because the pathologist examines the specimen “for tumor,” which requires more work and fits the 88309 definition.

2. Are other tissues separate ‘listed specimens’? The pathologist may receive a gastrectomy specimen with several associated tissues such as omentum, lymph nodes, duodenum and spleen. You need to know when to bundle tissues with the stomach specimen, and when to report them separately. “In most cases, when the pathologist performs separate examination and diagnosis of a tissue that CPT lists as a distinct surgical-pathology specimen, you should assign a separate procedure code in addition to the code for the gastrectomy,” Younes says.

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