Pathology/Lab Coding Alert

Question: How should we code a radical prostatectomy for adenocarcinoma with benign seminal vesicle and vas deferens?


Washington Subscriber


Answer: A radical prostate resection involves the entire gland and almost always includes attached seminal vesicles. The resection may also include a segment of vas deferens, fatty tissue and a portion of the junction to the bladder neck.

Submitted en bloc, a radical prostatectomy that includes attached seminal vesicles, surrounding fatty tissue and vas deferens fits the CPT definition of a surgical pathology specimen--tissue or tissues that is (are) submitted for individual and separate attention, requiring individual examination and pathologic diagnosis.

That means you should report the radical prostatectomy you described as 88309 (Level VI--Surgical pathology, gross and microscopic examination, prostate, radical resection). You should not code the seminal vesicles and vas deferens separately, even if CPT provides a separate code for the specimen (such as 88304, Vas deferens, other than sterilization).

With a radical resection, you would expect to receive small amounts of other tissue attached to the prostate, and you shouldn't code them separately. Although not specified by CPT, the College of American Pathologists (CAP) has advised that you should always bundle seminal vesicles with a radical prostate resection. "Seminal vesicles are part of a radical resection of the prostate and would not be separately coded, even if submitted in a separate container," states CAP Today, July 1999.

One clear exception to bundling with a radical prostatectomy is lymph nodes. The surgeon does not typically remove regional lymph nodes attached to the prostate, so you should code those separately if the pathologist examines them. For each individually identified group of lymph nodes, report one unit of CPT 88307 (Level V--Surgical pathology, gross and microscopic examination, lymph nodes, regional resection).