A lymph node for lymphoma workup refers to a lymph node, typically enlarged, submitted under clinical suspicion of lymphoma, when work beyond that ordinarily required for a lymph node biopsy specimen is performed. The tissue can be acquired by excision or core needle biopsy of the lymph node in question.
Lymphoma workup is a time consuming and demanding procedure because the specimen arrives fresh and requires immediate action. There are different protocols of lymphoma workup depending on the size of the specimen. These can include
• regular [H&E] histology
• touch imprints
• flow cytometry
• snap freeze for molecular biopsy studies
• cytogenetics for chromosomal analysis
Lymph node, lymphoma workup isn’t listed in the CPT® book, but it equates to a sentinel lymph node from a pathologist work perspective; CPT code 88307 is assigned when such a specimen—and the extra work associated with it—are properly documented in the final pathology report. The extra work that must be documented will include at least one of the following:
• touch preparation or frozen section to assess specimen adequacy and determine what, if any, special studies are appropriate
• H&E sections beyond the number typically associated with a lymph node biopsy
• flow cytometry immunophenotyping
• molecular pathology
• and/or immunohistochemistry
What makes a particular lymph node eligible for reporting with 88307 is the extended process required to derive the pathologic diagnosis, not necessarily the diagnosis itself. The mere fact that a lymph node biopsy is diagnosed with lymphoma doesn’t itself warrant reporting 88307 for the specimen. On the other hand, if clinical history indicates a significant probability of lymphoma and the lab’s lymphoma workup protocol is invoked, you’d report 88307 for the specimen even if lymphoma wasn’t confirmed by pathologic examination. Using the keywords “lymphoma protocol” or “lymphoma workup” should be documented for best audit-proof charge support.
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