Hi all!
We would like to get an opinion on unbundling and reporting lymph nodes correctly that would stand up to an audit on a radical neck dissection. I'm warning you all ahead of time, this is kind of lengthy to read but i need to give all info
Per Paget's - it states "report 88307 once per each node group that is individually identified and diagnosed; for example, if nodes from both sides of the neck come to the lab in separate containers, post 88307 x 2, alternatively report 88307 multiple times if the surgeon orients the overall dissection in such a way that the pathologist is able to report individually on the nodes at each level".
On the case that we were working on, we were able to separate out the nodes from each level (and it was documented in the report which specific levels positive lymph nodes were found in) and part of the report in question it was set up as:
Lymph node, right neck levels II–V, modified radical neck dissection:
- Metastatic squamous cell carcinoma in at least 8 of 28 lymph nodes (8/28).
- Largest metastatic focus is 2.5 cm (involves at least 6 matted lymph nodes); extranodal extension present.
- Metastatic carcinoma is present in levels II, III and IV.
- Metastatic carcinoma invades skeletal muscle.
With the lymph node codes as being 88307 x 3 and 88305 x 1 (as level 5 node only had 2 nodes in it and our pathologists don't like to upcode to the 307 unless there's 3 or more nodes)
Now our question is- Is this enough documentation to hold up to an audit or would we have to set it up such as:
- Level II: 3/8 positive nodes
- Level III: 4/4 positive nodes
- Level IV: 3/3 positive nodes
- Level V: 2/3 positive nodes
(and I know my math isn't correct on this from the documentation above, I was just giving an example)
And also, our gross description for this case separated the nodes by level and the doc did mention which levels the positive nodes were in - so would the first example be ok or would the 2nd one - or if even both would be alright?
Thank you in advance for the brave souls that wanted to tackle this lengthy post and give us your opinions!!
We would like to get an opinion on unbundling and reporting lymph nodes correctly that would stand up to an audit on a radical neck dissection. I'm warning you all ahead of time, this is kind of lengthy to read but i need to give all info
Per Paget's - it states "report 88307 once per each node group that is individually identified and diagnosed; for example, if nodes from both sides of the neck come to the lab in separate containers, post 88307 x 2, alternatively report 88307 multiple times if the surgeon orients the overall dissection in such a way that the pathologist is able to report individually on the nodes at each level".
On the case that we were working on, we were able to separate out the nodes from each level (and it was documented in the report which specific levels positive lymph nodes were found in) and part of the report in question it was set up as:
Lymph node, right neck levels II–V, modified radical neck dissection:
- Metastatic squamous cell carcinoma in at least 8 of 28 lymph nodes (8/28).
- Largest metastatic focus is 2.5 cm (involves at least 6 matted lymph nodes); extranodal extension present.
- Metastatic carcinoma is present in levels II, III and IV.
- Metastatic carcinoma invades skeletal muscle.
With the lymph node codes as being 88307 x 3 and 88305 x 1 (as level 5 node only had 2 nodes in it and our pathologists don't like to upcode to the 307 unless there's 3 or more nodes)
Now our question is- Is this enough documentation to hold up to an audit or would we have to set it up such as:
- Level II: 3/8 positive nodes
- Level III: 4/4 positive nodes
- Level IV: 3/3 positive nodes
- Level V: 2/3 positive nodes
(and I know my math isn't correct on this from the documentation above, I was just giving an example)
And also, our gross description for this case separated the nodes by level and the doc did mention which levels the positive nodes were in - so would the first example be ok or would the 2nd one - or if even both would be alright?
Thank you in advance for the brave souls that wanted to tackle this lengthy post and give us your opinions!!