Per Paget's it would be an 88304
Nail, Nail Bed or Scrapings for Fungal Infection (88304). Clinicians will at times submit a
nail (fingernail or toenail) or portion thereof (nail bed or scrapings) to pathology for evaluation
for fungal infection (e.g., onychomycosis). If the pathologist determines that a microscopic exam
of the primary tissue (nail and/or soft tissue bed) is medically indicated, the work is appropriately
reported with code 88304 (Level III) according to the AMA. {AMA CPT Information Services,
letter dated July 9, 2004} A special stain (e.g., PAS) will almost certainly be applied as well to
determine if fungal infection is present, and code 88312 is separately reported for it. Should the
nail require decalcification prior to paraffin embedding, report code 88311 for that procedure.
Obviously, all work (H&E light microscopy, special stain, and/or decalcification) must be
adequately demonstrated in the pathology report to support the various charges.
Heads-Up: The pathologist may determine after macroscopically examining the nail, nail
bed or scrapings that the primary tissue itself doesn’t warrant microscopic examination via H&E
sections. Instead, he or she will report the primary specimen “gross-only.” Nonetheless, a portion
of the specimen will be processed for special stain application to determine if a fungal infection
exists. In this instance, you’d report code 88300 (Level I) for the primary examination and code
88312 for the special stain. According to the AMA, code 88300 denotes a “primary service” that
supports a special stain code (88312-88319). {Ibidem}
Sentinel Lymph Node (88307). The term refers to a sentinel
