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Lymphoma Workup

Per the Pathology Service Coding Handbook published by The American Pathology Foundation, a lymph node for lymphoma workup refers to a lymph node, typically enlarged, and submitted under clinical suspicion of lymphoma, when work beyond that ordinarily required for a lymph node biopsy specimen (e.g., a high axillary node in conjunction with a breast mastectomy) is performed. 

There are different protocols of lymphoma workup depending on the size of the specimen. Most institutions include…
•    regular [H&E] histology, 
•    touch imprints, 
•    flow cytometry, 
•    snap freeze for molecular biopsy studies, 
•    [and/or] cytogenetics for chromosomal analysis. 

Lymphoma workup is a time consuming and demanding procedure because the specimen arrives fresh and requires immediate actions.  

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 biopsy eligible for reporting with 88307 is the extended process (i.e., the “lymphoma workup” protocol) required to derive the pathologic diagnosis, not the diagnosis, per se. 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 though lymphoma wasn’t confirmed by pathologic examination.

Resources:        

2019 CPT Text, published by the American Medical Association
2020 Pathology Service Coding Handbook, published by The American Pathology Foundation
 

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