Using pathology codes part two | aad.org
Using pathology codes, part two

Cracking the Code

Dirk Elston

Dr. Elston, who serves as director of the Ackerman Academy of Dermatopathology in New York, has served on the AMA-CPT Advisory Committee.

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I’ve heard that pathology for a melanoma excision can be coded as 88307. Is this correct?

No. The pathology code for a melanoma excision is correctly coded as 88305.

Surgical pathology codes (88300-88309) are used to report gross and microscopic examination of surgical specimens. Codes 88300 88304 were discussed in last month’s column. This month, we will focus on codes 88305 88309 as well as other pathology codes that might be reported by a dermatologist. It should be noted that all of these codes include accessioning, examination, and reporting, so those services should not be reported separately.

88305

Code 88305 is used for most skin specimens requiring gross and microscopic examination, excluding specimens where no pathology is expected (88302, including normal newborn foreskin and plastic repair), and conditions that should be reported with code 88304 (abscess, cyst, cholesteatoma, conjunctival biopsy, Dupuytren’s contracture, fissure or fistula, foreskin other than newborn, hematoma, mucocele, pilonidal sinus, skin tag(s), debridement, lipoma, and varicosity).

In addition to being used for most skin specimens, Code 88305 is also used for temporal artery biopsy, oral mucosal biopsies, lymph node biopsy, and muscle, soft tissue, nerve, or salivary gland biopsies.[pagebreak]

88307

This code would rarely be reported by a dermatologist or dermatopathologist. Appropriate use would include bone biopsy or curettings, regional lymph node resection, sentinel lymph node, and deep soft tissue mass (except lipoma).

88309

It would be extraordinary for a dermatopathologist to report this code, but appropriate use could include examination of a deep soft tissue tumor requiring extensive resection, and total vulvar resection.

88311-88342

Additional pathology codes that may be reported by a dermatologist include 88311 (decalcification procedure), 88312 (special stains; Group I for microorganisms, including acid fast and methenamine silver), 88313 all other histochemical stains (e.g., iron, trichrome), 88342 (immunoperoxidase studies), 88314 (histochemical staining with frozen section), 88321(consultation on referred slides), 88323 (consultation on referred material requiring preparation of slides), 88325 (consultation with review of records and specimens), 88329 (pathology consultation during surgery), 88331 (frozen section, first block), and 88332 (frozen section, each additional tissue block).[pagebreak]

Example 1:

You receive a 3 cm excision specimen of a large keratoacanthoma from a lower leg. It requires multiple blocks and takes you considerable time to read it. You are used to billing by time for unusually prolonged clinical services or attaching modifier 22 for unusually prolonged procedural services, but you don’t think you can do that for pathology services, so you report 88305.

Correct: 88305 is valued based on a typical service. Some specimens require more work, others less work than the “typical specimen,” so at the end of the day it usually balances out.

Example 2:

You receive an excision specimen for a rapidly growing nodule thought to represent a keratoacanthoma, but on examination, it is a deep abscess. You report your reading using the code 88305.

Incorrect: The proper code for gross and microscopic examination of an abscess is 88304.

Example 3:

You receive a biopsy specimen from a palm, with the clinical history “palmar nodule, favor fibromatosis.” Microscopic examination confirms the diagnosis of Dupuytren’s contracture. You report your reading using the code 88305.

Incorrect: The proper code for gross and microscopic examination of Dupuytren’s contracture is 88304.[pagebreak]

Example 4:

You receive outside slides from a patient with a cryptic eruption suspicious for connective tissue disease. You review the slides as well as copies of all of the clinic notes and serology reports provided. You report your reading using the code 88325.

Correct: Code 88325 is used to report consultation with review of records and specimens.

Example 5: 

You receive outside slides and a paraffin block from a patient with alopecia. You review the slides, but they are non-diagnostic, so your lab prepares additional serial sections cut from the paraffin block. You report your reading using the code 88321.

Incorrect: Code 88321 is used to report consultation on referred slides. 88323 is the correct code for consultation on referred material requiring preparation of slides.

Example 6: 

You receive a biopsy specimen from the lower leg, with the clinical history “eczema vs. psoriasis.” Microscopic examination demonstrates neutrophils within the stratum corneum, but no readily identifiable fungi. You order a GMS stain which confirms the absence of fungi and supports a diagnosis of psoriasis. You report your reading using the codes 88305 and 88312.

Correct: The proper code for microscopic examination of the skin is 88305. 88312 is the correct code for Group I special stains for microorganisms, including acid fast and methenamine silver.