Pathology/Lab Coding Alert

Now that you know the rules for coding intraoperative pathology consults, give your new skills a workout by trying your hand at the following cases:

Scenario 1: The surgeon requests a pathology consultation during surgery on a nerve tumor in the ankle region. The pathologist examines frozen sections cut from a single block from the central tumor mass and gives a preliminary diagnosis of malignant peripheral nerve sheath tumor. The pathologist also examines touch preps from the proximal and distal margins and diagnoses each as neurofibroma -- negative for malignant peripheral nerve sheath tumor.

Solution 1: Code the frozen section from the central tumor mass as 88331 (Pathology consultation during surgery; first tissue block, with frozen section[s], single specimen).

"Because you have documentation that the touch preps are from two different sites distinct from the central tumor mass involved in the frozen section diagnosis, you can also report two intraoperative touch preps," says Melissa Sinclair, CPC, an independent consultant based in Denver.

The correct coding is two units of 88334 (Pathology consultation during surgery; cytologic examination [e.g., touch prep, squash prep], each additional site). You should append modifier 59 (Distinct procedural service) to indicate that the pathologist evaluated two touch preps from distinct sites separate from the frozen sections.

Scenario 2: The pathologist evaluates a thyroid lesion removed from the left lobe during surgery, examining slides from two frozen section blocks. He also examines a touch prep from the tumor mass to evaluate intranuclear inclusions and linear grooves that might be helpful in identifying the tumor type.

Solution 2: Report the intraoperative consultation on the frozen section blocks as 88331 for the first block and 88332 (Pathology consultation during surgery; each additional tissue block with frozen section[s]) for the second block.

Because the touch prep is from the same site on the thyroid tumor mass as the frozen blocks, you should not additionally report 88334 to Medicare or other payers that follow the Correct Coding Initiative (CCI) bundling rules.

"Medicare considers a frozen section and touch prep evaluations from the same location to be redundant, even though the two procedures may yield different clinical results that impact the diagnosis," Sinclair says.

Scenario 3: The pathologist consults on a breast case during surgery, evaluating two frozen section blocks from the breast lesion and a touch prep from the sentinel lymph node.

Solution 3: Report the two frozen section consultations as 88331 and 88332. Because the touch prep is from a separate specimen -- the sentinel lymph node -- not a different site on the breast, you should report 88333 (Pathology consultation during surgery; cytologic examination [e.g., touch prep, squash prep], initial site) instead of 88334. Because CCI also bundles 88331 with 88333, you should append modifier 59 to 88333, which is the column 2 code.