neck dissection billing question

[hellojed]

Surgeon sent levels 1A, 1B, 2, 3, and 4/5 in 5 separate containers. Should this be 88307 x5 or 88307x1, since they are all technically part of one side of a neck dissection?

Thanks!

Edited to add: The main specimen is a glossectomy (i.e. not a larynx which has bundling for lymph nodes).

---

Members don't see this ad.

 

[Gene_]

Each gets billed separately, 88307 x 5. You can even bill multiple 88307's if received in a single container, but the different levels are designated by the surgeon somehow (e.g. sutures).

 

[AZpath]

That's kinda tricky. Some how I think bundling rules trump the separate IDs. Also, If it is single LN does it get a 88305?

 

[Euchromatin]

Each gets billed separately, 88307 x 5. You can even bill multiple 88307's if received in a single container, but the different levels are designated by the surgeon somehow (e.g. sutures).

Completely agree. The newest version of the coding handbook my group uses indicates the same thing:

Report 88307 once per each node group that’s individually identified and diagnosed;
for example, if nodes from both sides of the neck come to the lab in separate containers, post
88307 two times. 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. (It’s conceivable that the surgeon might split a regional node group into sublevels
and submit each as an individual specimen; for example, the level II nodes might come
to the lab in vials A and B. In that instance you’d code separately for levels II-A and II-B,
assuming each is individually diagnosed by the pathologist.)

You can also add an additional code for separate structures, like submandibular gland, SCM muscle and mandible if they are included and you mention them specifically in your final diagnosis.

 

[AZpath]

How about this one.
Mastectomy
Sentinel node
Lymph node
partial axillary dissection.
(Separate labels and containers)

88309 , 88307 ( lymph nodes bundled)

Or 88307, 88307, 88305, 88307 ?

 

[musom]

the later for sure.

 

[musom]

How about this?

Mastectomy
Additional lateral margin
Additional medial margin
Additional superior margin

 

[Gene_]

For me, it depends if it's a total or partial mastectomy. If total, I would bundle the breast and axillary dissection into an 88309 (this is essentially a modified radical mastectomy). Sentinel is 88307 and the single node is 88305. If it's a partial, you wouldn't bundle breast and nodes.

Some pathologists in my group would not bundle anything and would bill 88307 x 3 and 88305. I think either way is acceptable.

 

[AZpath]

What are you calling a partial mastectomy?
There is no question a lumpectomy gets 88307.


The are few things opening to interpretation.

For most things there is only one correct to code.

 

[Gene_]

A lumpectomy and partial mastectomy are the same thing.

Most things are straightforward to code. However, there are lots of things where you have to use your best judgement. For example, see musom's question above with additional breast margins. Those can be either coded 88307 or 88305. You have to decide for yourself which is appropriate.

 

[AZpath]

Thanks.

Btw, I think a 88309 should reserved be for a true modified radical with a full axillary dissection ( even submitted separately).

I see mostly simple mastectomies so 88307 plus each additional code works

 

[ygdrasil]

Completely agree. The newest version of the coding handbook my group uses indicates the same thing:

Report 88307 once per each node group that’s individually identified and diagnosed;
for example, if nodes from both sides of the neck come to the lab in separate containers, post
88307 two times. 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. (It’s conceivable that the surgeon might split a regional node group into sublevels
and submit each as an individual specimen; for example, the level II nodes might come
to the lab in vials A and B. In that instance you’d code separately for levels II-A and II-B,
assuming each is individually diagnosed by the pathologist.)

You can also add an additional code for separate structures, like submandibular gland, SCM muscle and mandible if they are included and you mention them specifically in your final diagnosis.

What book are you using, Eurchromatin? (We're operating off a cheat sheet someone got from University of Michigan).

 

[Euchromatin]

What book are you using, Eurchromatin? (We're operating off a cheat sheet someone got from University of Michigan).

This one produced by the American Pathology Foundation. I had never heard of the organization or this publication until I joined the group I am currently with.

https://www.apfconnect.org/pathology-service-coding-handbook.php