Hi
serennaodonnell,
I have had to unfortunately code these procedures. When you review the pathology report, and they provide that neat little table of the exact location of cancer and the margins and the measurements to the margins and whether or not lymph nodes were reviewed did the pathologist state "radical resection performed" for the procedure? That is where I would check first. Second, if you have access to the surgery report(s) - what did it state? [These procedures are rare, and I clearly don't want to put my foot in my mouth] but these procedures in a sense, almost seem to be quite consuming with lots of effort to completely remove the cancer entirely (I commonly saw Modifier 22 mentioned for the surgical procedure which would be almost appropriate for this type of surgical case because of the extra time and work to completely remove the cancer and the documentation the surgeon(s) provided for review).
Let me share a story that I had just last year with a member from my pathology team (a very well known, respected, and seasoned pathologist). It is on a case not exactly like this, but similar. Let me describe the scenario. We had a patient that had liposarcoma in the thigh area and they had to amputate the leg midthigh. That is what was presented to the pathology department for review - for the pathologist's professional interpretation. It was accessioned with 88307 and I was to review the pathology report for proper diagnosis assignment and validate CPT assignment. Like you stated - this isn't a scenario exactly found in our pathology manual. So, I did ask this very question to my pathologist on what they felt the proper CPT assignment should be (we were in AB1x for blocks). I was told that when you have to "take enough to get clean margins - it was 3 something off the top of my head", they really had to take the leg, the bone was within the margins. I had never seen a pathology report quite like this - but the pathologist was a master and measured everything. The length to the bone and the length to clear "established" margins for Liposarcoma. There was no way to get around not performing the amputation when the goal was to have "clear margins".
Again, please look at the pathology report, review the operative report, query your pathologist (they usually do not accession their own cases because someone else does, and just simply ask their opinion on if they really felt that ("CPT code 8830x was appropriate for the amount of work they provided for this accession, or if a different Level of Gross and Microscopic may be more appropriate for this case"). I don't make the decisions, the pathologist's do. Thank you for questioning it. I would rely on a conversation with your pathologist on this one (how much work was performed - did it warrant 88305, 88307 or 88309) and proceed with their opinion.
Thank you for listening and have a great evening,
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT