subject: 88304 Or 88305 - Which Is A Better Choice For Ligament? [print this page] My pathologist states that the work for a ligament specimen exam is equal to a soft tissue specimen. Is it okay to code the ligament specimen as 88305 in place of 88304?
Well, the answer is a conditional yes. As because 'ligament' is an unlisted specimen, you should code the service based on the physician work involved in comparison to similar specimens, as per CPT instruction. If your pathologist says the work is similar to a soft tissue specimen, the proper code would be 88305 (Level IV -- Surgical pathology, gross and microscopic examination, soft tissue, other than tumor/mass/lipoma/debridement).
That said, you should be wary about reporting 88305 for a ligament specimen. The question points to the fact that you are aware of the general standard that a ligament is equivalent for average physician work, to listed specimens under 88304, specifically, tendon. A more conventional coding for a ligament specimen would be 88304 (Level III -- Surgical pathology, gross and microscopic examination, ), which lists specimens like tendon/tendon sheath". If your pathologist regularly lists ligament as88305, you may have trouble justifying the position in an audit. However, if your question deals with a specific ligament specimen that your pathologist finds tougher and thus equivalent to soft tissue, you could use 88305 with proper documentation that shows work equivalent to an 88305 specimen.
Slippery slope: Equating unlisted specimens to soft tissue can lead to code inflation for instance, if your pathologist equated a tendon to a soft tissue biopsy. CPT lists soft tissue under three codes in addition to to 88305:
