Skip to content
CPCSTUDY COURSEMy progress

CPC STUDY COURSE · 2026 EDITION

Two colon specimens, several fragments and one pathology report

Read an original fictional chart, identify the supported facts, and explain your coding workflow.

Chart gym · Original fictional record

Service date: 2026-09-08 · Professional outpatient claim; Original Medicare unless stated otherwise

Use your code books and write your reasoning before opening the walkthrough. This exercise contains no real patient information.

Specimen origin

Fictional patient Quinn Mercer, age 63, has two distinct colon lesions removed by a separately reporting endoscopist. The procedure note and labels identify lesion A in the ascending colon and lesion B in the descending colon. The pathology worksheet concerns the examination of the submitted tissue, not the endoscopist’s removal technique or a screening-modifier decision.

Accession record

Specimen A arrives in a container labeled ascending-colon polyp and contains three fragments from that one lesion. Specimen B arrives separately, labeled descending-colon polyp, and contains four fragments from its one distinct lesion. The labels and requisition agree. These are not seven separately identified lesions and not fragments combined from uncertain sites.

Performed examination

The pathology service performs the appropriate gross and microscopic examination for each specimen. Routine processing produces several blocks and slides. No special stain, immunohistochemistry, molecular assay or separate intraoperative consultation is performed. The service must use the current licensed specimen entry and applicable reporting-component instructions.

Final report

The signed report diagnoses benign tubular adenoma in both specimens, with no carcinoma. The treating provider adopts the final findings and preserves their different colon sites. The final report combines the two specimen results into one document but identifies each specimen and diagnosis separately.

Coding desk

A trainee proposes seven surgical-pathology units from the fragment count, or alternatively one unit because only one report was signed. Another draft uses an unspecified colon site for both findings. Determine the correct specimen-based reasoning, preserve the site-specific benign diagnoses and remove tests that were never performed.

Your coding worksheet

  1. Identify the reason for this encounter and the supported diagnoses.
  2. List the services actually completed and the applicable code sets.
  3. Use your books to select final codes, units and any supported modifiers.
  4. Sequence the diagnoses and explain the relevant instruction.
  5. Review included work and any separate coverage question. Explain why the strongest alternative does not fit.

In your notebook, record the supported facts, your index route, the instructions you checked, and any missing detail that limits your answer.

Write your answer

Use only this fictional record. Your entries stay on this page and disappear when you leave or reload. Do not enter real patient information.

Compare with the worked explanation
  1. The record identifies two separate lesion specimens requiring individual examination. NCCI X M.8 bases the described gross and microscopic surgical-pathology unit on the specimen, not on every fragment, block or slide.
  2. Three fragments from A remain one specimen; four fragments from B remain another. There are two specimen units to assess under the applicable licensed entry, not seven units.
  3. One combined report does not collapse the two separately identified specimens into one. Conversely, splitting one specimen’s report into pages would not multiply its units.
  4. The adopted benign adenomas retain their sites: D12.2 for ascending colon and D12.4 for descending colon. Follow the adenoma/neoplasm table route and verify each Tabular entry. Do not substitute an unspecified site or malignancy.
  5. No special stains, immunohistochemistry or molecular testing were performed. Their availability at the laboratory is not evidence that they belong on this patient’s claim.
  6. Keep the pathology reporting role separate from the endoscopist’s work. Use the current complete specimen entry and component instructions for the service actually furnished; do not infer a removal technique from the fragments.

Reference sections: NCCI X M.8; D12.2,D12.4; neoplasm table

Practice the linked chart questions

Review the lesson

Sources

  1. CMS — Medicare NCCI 2026 Chapter X: Pathology and Laboratory. 2026. Accessed 2026-09-10.
  2. CDC NCHS — ICD-10-CM April1,2026 Index and Tabular XML. April1–September30,2026. Accessed 2026-09-12.
  3. CDC/NCHS and CMS — ICD-10-CM April 1 2026 Guidelines. FY2026 April. Accessed 2026-09-10.

Return to the chart gym →