Coding Question - Sentinel Lymph Nodes / 88331, 88387, 88388
17 October 2011
Management Home Page

We received a sentinel lymph node with a request to send out a portion of tissue for molecular studies. The molecular studies required the pathologist to dissect the lymph node under sterile conditions. A portion of lymph node was submitted for frozen section diagnosis and after the results were reported to the surgeon, a portion of tissue was prepared for send-out. How should we bill for the intraoperative services?

Report one unit of 88331 (Pathology consultation during surgery; first tissue block, with frozen section(s), single specimen) and one unit of 88388 (Macroscopic examination, dissection and preparation of tissue for non-microscopic analytical studies (eg, nucleic acid-based molecular studies); in conjunction with a touch imprint, intraoperative consultation, or frozen section each tissue preparation (eg, a single lymph node) for these services.

Codes 88387 (Macroscopic examination, dissection and preparation of tissue for non-microscopic analytical studies (eg, nucleic acid-based molecular studies); each tissue preparation (eg, a single lymph node) and 88388 were created to report the complex macroscopic examination and dissection performed prior to the molecular studies. These services should not be confused with the routine gross procedures performed on these specimens. The 88387 and 88388 codes are reported only when additional work, such as maintaining sterile conditions to prevent cross-contamination, is required for molecular testing. Parenthetical statements in CPT clarify that these codes should not be reported for the preparation of tissue for microbiologic cultures or flow cytometric studies.

These coder services should also not be reported for the routine gross evaluation of specimens. Therefore, report documentation should clearly outline the additional work involved in examining the tissue. Statements regarding the maintenance of sterile conditions, gross features leading to selection of tissue and subsequent packaging and labeling can be included in an intraoperative section of the report, or in the gross description.

Please note: CPT code 88388 is an add-on code, which means this may only be billed in conjunction with a primary consultation procedure code (88329-88334). Code 88387 is a stand-alone code that does not require an additional code for reporting.

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