July 2008
Feature Story

Q: We received a nephrectomy specimen with adrenal gland for renal cell carcinoma. Is it appropriate to assign it a CPT code other than 88307, Level V—surgical pathology, gross and microscopic examination?

A: The adrenal gland is not intrinsic to a nephrectomy. It should be considered an unlisted specimen when it is attached to the kidney. The gland should be assigned a code appropriate for the work involved in examining it.

Q: Our cytology lab routinely receives bronchial washings and bronchial brushings (two separate specimens) from a bronchoscopy. The specimens come to us labeled as “left lower lobe bron­chial brushing” and “left lower lobe bronchial washings.” We assign both specimens CPT code 88108, Cytopathology, concentration technique, smears and interpretation (e.g., Saccomanno technique), since we prepare slides from the submitted samples. We add the -59 modifier to one of the charges. However, Medicare’s Correct Coding Initiative states that the -59 modifier does not apply since both specimens are from the same anatomic site. How should we handle billing in this situation?

A: Although the bronchoscopy may be considered a single procedure, the specimens generated required individual attention and reporting. The unit of service for cytologic evaluation is the specimen. When there are two defined specimens, two units of CPT code 88108 are correct for the service provided as long as a report has been issued for both. Some payers require the –59 modifier to show that the laboratory received two specimens.