Pathology/Lab Coding Alert

Question: We recently received in separate containers the index finger and the middle finger from a patient's right hand. The clinical diagnosis was "traumatic amputation," and the pathologist's finding was consistent with that diagnosis. Because the CPT text lists "fingers/toes" as plural, does this mean we have to bundle the two fingers under one code for billing?

Minnesota Subscriber

Answer: "When CPT lists a test or procedure in singular form, it typically means 'each,' whereas the plural form usually means 'as many as apply,' " says Dennis L. Padget, MBA, CPA, FHFMA, president of Padget & Associates, a pathology financial and compliance consulting firm in Simpsonville, Ky. Because of CPT's convention for using plurals, practitioners have assumed they had to bundle two or more fingers from the same hand or two or more toes from the same foot under a single 88302 or 88305 code. For the same reason, many coders believed that they had to bundle other plural listed specimens, "hemorrhoids" or "inflammatory nasal polyps," even when separately labeled. "But recent, specific guidance I received from the CPT Information Services unit of the AMA overturns that conventional wisdom," Padget says.
 
In one response, CPT Information Services cited the CPT "specimen" definition - "tissue or tissues that is (are) submitted for individual and separate attention, requiring individual examination and pathologic diagnosis" - and stated:
 
This is intended to indicate that 1) tissues submitted separately should be identified by separate surgical pathology codes according to the type of tissue being examined, and 2) if multiple tissues are submitted together and notated for individual attention, then separate codes should be used to identify each tissue separately addressed. Multiple tissues submitted as part of one specimen (i.e., processed as one specimen) should not be individually reported.

 In response to specific scenarios involving finger or toe specimens, CPT Information Services advised that the
"s" added to each word in the text does not indicate an exception to the general "separately identified/separately charged" rule set forth above. For example, when the pathologist received the right index and right middle fingers in separately labeled containers and individually diagnosed each finger, you should report two units of 88302 (Level II - Surgical pathology, gross and microscopic examination, fingers/toes, amputation, traumatic) when the amputation results from trauma, according to CPT Information Services.
 
In another scenario, the pathologist received separately labeled containers with the "R great toe" and "R second toe" and reported findings of "A) & B), right 1st & 2nd toe, amputation: gangrenous cellulitis (785.4)." CPT Information Services stated that you should report this service as 88305 x 2, (Level IV - Surgical pathology, gross and microscopic examination, fingers/toes, amputation, nontraumatic).
 
"If the toes had arrived in the same container, but the requisition stated, "R great toe" and "R second toe," I'm confident the AMA would still advise reporting 88305 x 2, because a pathologist can readily distinguish a great toe from another digit," Padget says. But if the requisition for a single container states "toes," you should report a single unit of 88305, Padget says, because the AMA states that "multiple tissues submitted as part of one specimen should not be individually reported."
 
In response to other inquiries, CPT Information Services advises that you should report multiple units of 88304 (Level III - Surgical pathology, gross and microscopic examination, hemorrhoids) for multiple pieces of hemorrhoidal tissue that the surgeon separately identifies (such as internal and external hemorrhoids in separately labeled containers). Similarly, you should report multiple units of 88304 (... polyps, inflammatory - nasal/sinusoidal) for separately identified and diagnosed inflammatory nasal polyps.