Rectal mucosal resection CPT query

[ygdrasil]

Another coding question. Occasionally we'll get a rectal mucosal resection instead of a segment. The clinical history is usually a polyp with high grade dysplasia or a patient that wouldn't tolerate the larger surgery. We formerly had been coding these as 88305s. A similar specimen from the esophagus is an 88309, but I can't find an explicit colorectal code to apply.

Argument for 88309: I orient and ink the specimen differentially. I submit it entirely. It's a giant pain at the 'scope due to fragmentation, cautery, and ulceration.

Argument against 88309: No nodes.

Any thoughts?

 

[2121115]

Its an 88305. No way you can get away with an 88309.

 

[ygdrasil]

And your rationale? Isn't it essentially the same specimen and workup as the esophageal mucosal resection?

 

[2121115]

It isn't about rationale.

 

[pathstudent]

Agreed. If coding was rational a placenta gross micro wouldn't reimburse the same as an 80gram lumpectomy specimen.

 

[Johnny Sunshine]

I'm not clear on why you wouldn't "get away with it". Both are mucosal resections to remove high grade dysplasia and confirm the presence/absence of carcinoma. From what I understand of the clinician's and patient's perspective, the potential results have similar clinical impact as well. Seems like a reasonable discussion to me.

I'm sure whoever has to pay for the reimbursement will do what they can to justify a lower code though.