Wiki "significant pathology" in ovary and tubes

[kate8]

I code for a pathology department, and see many hysterectomy cases. Very often the report lists the tubes and ovaries separate from the Uterus (ie; specimen 1: R Tube and Ovary; specimen 2: L Tube and Ovary; specimen 3: Uterus). Padget says they must be bundled together if "significant pathology" is not expected or found in the tubes or ovaries, but I cannot find a definition of "significant pathology". Many times the tubes and/or ovaries will have follicle, or paratubal cysts - would this be considered significant enough pathology? And if the patient has a history of endometiral cancer, would this fall into the "significant pathology expected" category?

I understand that if any other tests are done on the specimen (ie, frozen sections, etc) can determine whether they are coded separately. But my question is about about what would be considered "significant pathology" if all these other issues are not present.

On a stand alone ovary/tube, serous cystadenoma or teratoma would be considered sig. pathology and thus an 88307 and separately chargeable, and that serous cyst is not neoplastic so thus 88305. But with a hysterectomy and salpingo-oophorectomy, is serous cyst significant enough to charge separately? And what about follicle derived cysts or paratubal cysts? These are not neoplastic, but I don't know if they would be considered significant enough to warrant having the ovary/tube coded separately from the Uterus.

Any thoughts, feedback?

Thank you!

 

[megan518]

Hope this helps...

I don't know a whole lot about the 'significant pathology' definition either, but here are some codes and a bundling rule my pathology department goes by:

Uterus
Endometrial Curettings 88305
With or Without T/O For Prolapse 88305
Leiomyoma Without Uterus (myomectomy) 88305
With or Without T/O, for Leiomyomas 88307
With or Without T/O, Other Than Prolapse 88307
With or Without T/O, Simple Hyperplasia 88307
With or Without T/O, Atypical Complex Hyperplasia 88309
With or Without T/O, Cervical High Grade Dysplasia 88309
With or Without T/O, Cervical Carcinoma 88309
With or Without T/O, Neoplastic (not Leiomyomas) 88309

*Note: Bundling rule: When the tubes and ovaries are removed
incidentally to hysterectomy, or a tube is removed incidentally
to ovarian resection, physician work is not increased significantly
and only a single code is used, even if the surgeon places the
organs in different containers. An example of this is a uterus
removed for leiomyoma with both ovaries and tubes showing no
significant pathology, even if submitted as separate specimens,
all is coded as a single 88307. A separate code for ovary and
fallopian tube should only be used when the findings in the
ovary/tube are significantly different or require significant
additional work to justify additional codes. Examples where
additional codes for ovary/tube are justified include a separate
neoplasm in the ovary/tube or metastatic involvement of the
ovary/tube by a neoplasm.


I hope this helps....


Megan

 

[kate8]

So the last sentence in your text "Examples where additional codes for ovary/tube are justified include a separate neoplasm in the ovary/tube or metastatic involvement of the ovary/tube by a neoplasm" would indicate that ovary/tube with non-neoplastic cysts of any kind would not justify a separate code. That is what I was looking for - thank you!

 

[whaleheadking]

Generally speaking, if tubes and/or ovaries are submitted separate from a uterus and they are neoplastic, they contain "significant pathology" that warrants individual examination and diagnosis. Non-neoplastic conditions should be considered incidental and the tubes and ovaries, even if separately submitted, should be bundled into the more comprehensive uterus code.

Neoplastic tubes and ovaries submitted in the same container as a uterus should be considered a part of an entire specimen and never be unbundled to keep to the letter of CPT. This is a tough specimen to adjudicate since there are a lot of variables and the rules are designed not to overcharge female patients for circumstances beyond their control. If you have set, consistent, coherent standards for reporting these exams, you should be okay. Unbundle with care and always with the mindset that you are reporting medically necessary, significant work on the pathologist's part while adhering strictly to the terminology of CPT.

Best,
WK

Surgical Pathology Coder.
www.whaleheadking.com