Pathology/Lab Coding Alert

Question: Our pathologist received a sentinel lymph node biopsy specimen for a breast cancer patient. During the gross exam, the pathologist examined and teased out a portion of the node, which he processed under sterile conditions, cutting thin sections to send of for molecular diagnostics testing for micrometastasis. The pathologist then examined the remainder of the sentinel lymph node, processing it as two blocks, cutting four levels of each block and performing S100 staining on three to five slides from each level. How should I code the pathologist's work?Wisconsin SubscriberAnswer: The sentinel lymph node biopsy warrants 88307 (Level V -- Surgical pathology, gross and microscopic examination, sentinel lymph node). For the additional molecular diagnostics preparation work, report 88387 (Macroscopic examination, dissection, and preparation of tissue for nonmicroscopic analytical studies [e.g., nucleic acid-based molecular studies]; each tissue preparation [e.g., a single lymph node]). For the immunohistochemistry (S100) staining, you can report two [...]