Wiki small bowel resection surgical pathology coding

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psnoopy1962@gmail.com

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I have a surgical pathology case for a small intestine with a non-neoplastic process where 4 separate segments of small bowel were submitted in one container. Each segment was grossed individually within that specimen. In the final dictation the pathologist says to the effect "four fragments of bowel were received and all four fragments show necrosis,.....". This was coded by the pathologist as 88307 x 4. Is this correct or can I only charge 88307 x 1 since all four segments were in the same container? Thanks for any insight.
 
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quantity four since each was grossed individually
below is a coding clinic it is old but there are no newer ones for two or more specimens

Pathological exam of two or more specimens
CPT Assistant, July 1999 Page: 10 Category:
Pathology and Laboratory
Question

If the laboratory receives a specimen labeled "right breast" from a patient undergoing a simple mastectomy, and then 60 minutes later receives a second specimen from the same patient, labeled right breast (containing additional breast tissue), how should I report the examination of the second specimen?

AMA Comment
Based on the surgical pathology guidelines in CPT, a specimen is defined as tissue or tissues submitted for individual and separate attention, requiring individual examination and pathologic diagnosis. Two or more such specimens from the same patient are each appropriately assigned an individual code that reflects the proper level of service. To answer your specific question, if both breast specimens are submitted separately, and are examined and assigned a pathologic diagnosis, then it would be appropriate to report each specimen separately with code 88307.
 
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psnoopy1962@gmail.com,​

My reply is possibly - I'll tell you why. our GI surgeons are savvy. You and I both know I have no idea why four lengths of small bowel were received by your pathology department for review, but I will assure you I have seen this before. What does the "GROSS Description" state? What has been inked?
Let me tell you what ~ I have seen this okay for this scenario clearly more than once and possibly this matches what you have at hand at coding pathology okay??
Received in specimen bucket
Length of small bowel 8" distal inked in blue and proximal inked in yellow
Length of small bowel 6" distal inked in black and proximal inked in red
Length of small bowel 10" distal inked in green and proximal inked in orange
Length of small bowel 5" distal double stitched and proximal not
When you review the gross description - they state the obvious the markings (including stained margins) and length of specimen and what the pathologist is observing - perforation, no abnormality, necrosis, or otherwise. I could sit here and type all night long what I have seen here. From my fictious "OFF THE TOP OF MY HEAD ASSESSMENT" you bill 88307x4 all day long and strong here.
If the GI surgeon threw it all in a specimen bucket for distinct and individual GROSS and MICROSCOPIC without marking (staining, stitching those areas that needed to be tended too) you are at the mercy of your pathology team to measure each length and distinguish it in their final pathology report. We already know dang well they did what they were supposed to do and reviewed it all and their GI procedures.
 
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nickelclaw said:
quantity four since each was grossed individually
below is a coding clinic it is old but there are no newer ones for two or more specimens

Pathological exam of two or more specimens
CPT Assistant, July 1999 Page: 10 Category:
Pathology and Laboratory
Question

If the laboratory receives a specimen labeled "right breast" from a patient undergoing a simple mastectomy, and then 60 minutes later receives a second specimen from the same patient, labeled right breast (containing additional breast tissue), how should I report the examination of the second specimen?

AMA Comment
Based on the surgical pathology guidelines in CPT, a specimen is defined as tissue or tissues submitted for individual and separate attention, requiring individual examination and pathologic diagnosis. Two or more such specimens from the same patient are each appropriately assigned an individual code that reflects the proper level of service. To answer your specific question, if both breast specimens are submitted separately, and are examined and assigned a pathologic diagnosis, then it would be appropriate to report each specimen separately with code 88307.
Click to expand...
Thanks for the insight!
 
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danachock said:

psnoopy1962@gmail.com,​

My reply is possibly - I'll tell you why. our GI surgeons are savvy. You and I both know I have no idea why four lengths of small bowel were received by your pathology department for review, but I will assure you I have seen this before. What does the "GROSS Description" state? What has been inked?
Let me tell you what ~ I have seen this okay for this scenario clearly more than once and possibly this matches what you have at hand at coding pathology okay??
Received in specimen bucket
Length of small bowel 8" distal inked in blue and proximal inked in yellow
Length of small bowel 6" distal inked in black and proximal inked in red
Length of small bowel 10" distal inked in green and proximal inked in orange
Length of small bowel 5" distal double stitched and proximal not
When you review the gross description - they state the obvious the markings (including stained margins) and length of specimen and what the pathologist is observing - perforation, no abnormality, necrosis, or otherwise. I could sit here and type all night long what I have seen here. From my fictious "OFF THE TOP OF MY HEAD ASSESSMENT" you bill 88307x4 all day long and strong here.
If the GI surgeon threw it all in a specimen bucket for distinct and individual GROSS and MICROSCOPIC without marking (staining, stitching those areas that needed to be tended too) you are at the mercy of your pathology team to measure each length and distinguish it in their final pathology report. We already know dang well they did what they were supposed to do and reviewed it all and their GI procedures.
Click to expand...
Thanks for the insight. I think i can proceed now with my case!
 
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