CPT Questions

June 2003

Q: Is an oriented needle-localization lumpectomy specimen, which turns out to be benign, coded as 88305 or 88307?

A. The final diagnosis is not the sole determining factor in assigning the appropriate CPT code for breast excisions. If the clinical assessment and mammography findings determine the need to assess adequacy of the excision (with microscopic evaluation of the margins) and the material is prepared and evaluated, then it should be coded accordingly. In this scenario, the appropriate code is 88307, Breast, excision of lesion, requiring microscopic evaluation of surgical margins.

Q: We often receive mammography films in conjunction with a breast specimen as a part of our complete surgical pathology consultation. Can we bill CPT code 76098 for our evaluation of the specimen mammogram?

A. CPT code 76098, Radiological examination, surgical specimen, can be reported if the films are interpreted as an integral part of the evaluation. Medical record documentation should reflect the interpretation as well as the evaluation. Because you did not perform the mammography, the professional component modifier (-26) should be appended to the CPT code. It should also be noted that Medicare generally does not pay for two physicians to read and interpret a film, so you may not receive payment if the radiologist has submitted a claim for the same service.

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 2006. CPT 2006 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.