Your CPT Questions

January 2007

Q: What is the correct coding for incarcerated omentum resected with the hernia sac? What is the correct coding for incarcerated omentum resected at the time of hernia repair?

A: The correct CPT code for the hernia sac is 88302. The incarcerated omentum is an unlisted specimen. Any unlisted specimen should be assigned to the code that most closely reflects the physician work involved when compared to other specimens assigned to that code. If the omentum is identified and submitted separately, it should be billed for independently of the hernia sac. If the omentum is incidental to the herniorraphy, it should not be billed for separately.

Q: If we ink and treat a breast excision for a mass as a possible malignancy but it ends up being benign, should we charge CPT code 88305 or 88307?

A: CPT code 88307 may apply if the lesion is mammographically, clinically, or grossly significantly suspicious for malignancy and warrants margin assessment and if the nature of the specimen allows for meaningful margin assessment. You should assess which biopsies or specimens warrant code 88305 or 88307 based on the clinical criteria and the nature of the specimen.

Frequently asked questions about CPT are published bimonthly in “Capitol Scan.” This section of CAP TODAY is a product of the CAP Economic Affairs Committee.

The codes and descriptions listed here are from Current Procedural Terminology, 4th ed., CPT 2007. CPT 2007 is copyrighted by the American Medical Association. To purchase CPT books, call the AMA at 800-621-8335.

For more information about CPT coding, visit the CPT Coding Resource Center on the CAP Web site.