Inpatient Facility Coding & Compliance Alert

Question:  Please clarify if there’s a difference in how we should bill the following two scenarios:

1. The surgeon sticks a needle into a lung lesion, pulls the trocar out, sticks the biopsy tool down the needle and fires the biopsy gun into the lesion, removing 1 cm of tissue which he touches to a slide and requests the pathologist examine immediately. The pathologist microscopically examines the smear from the biopsy and reports an immediate diagnosis back to the surgeon. The surgeon then fires the biopsy gun again through the same needle, submitting a second biopsy smear to the pathologist for immediate examination and report. Later, the pathologist provides a surgical pathology evaluation for both biopsies.
2. The scenario is the same except the surgeon moves the needle to a different lung lesion between the first and second biopsies/smears.

Arkansas Subscriber

Answer: There is a difference in how you should bill the intraoperative touch preps in the two scenarios, but billing the biopsy exam is the same.

Scenario 1: Because the surgeon removes a biopsy and requests an intraoperative touch prep exam from a needle insertion, then repeats the process from the same needle insertion, the two touch prep exams are from the same lesion, and you should bill them as follows:

• 88333 — Pathology consultation during surgery; cytologic examination (e.g., touch prep, squash prep), initial site
• +88334 — … cytologic examination (e.g., touch prep, squash prep), each additional site (List separately in addition to code for primary procedure).
• When the pathologist performs the evaluation for the two, separately submitted lung biopsies, you should report that work as two units of 88305 (Level IV - Surgical pathology, gross and microscopic examination, Lung, transbronchial biopsy).

Scenario 2: When the surgeon requests intraoperative touch preps from two distinct lung lesions, you should report the service as 88333 x 2 instead of 88333 and +88334. That’s because you’re not dealing with two sites from the same lesion, but rather, the initial site from two separate lesions.

In this scenario, you should also bill the two biopsy exams as 88305 x 2.