Pathology/Lab Coding Alert

Don't use Pap codes for endocervical -brushing biopsy-

Following an abnormal Pap, your pathologist receives an endocervical specimen for diagnosis--biopsy, curettage or brushing. How should you code it? Let our experts show you how to choose the right codes when you follow these guidelines:

Tip 1: Use Surgical Pathology Codes for Endocervical Tissue

When the surgeon submits an endocervical biopsy or curettage, you should list your pathologist's work as 88305 (Level IV--Surgical pathology, gross and microscopic examination; endocervix, curettings/biopsy). Although curettage, which involves scraping, is a different procedure than biopsy, which involves cutting tissue, CPT lists both biopsy and curettage specimens as 88305.

Don't miss: The pathology report might use terms such as -endocervical scrapings- or -ECC- for endocervical curettage specimens. Regardless of the name, you should code the pathologist's exam of an endocervical tissue sampling as 88305, says R.M. Stainton Jr., MD, president of Doctors- Anatomic Pathology Services in Jonesboro, Ark.

Tip 2: Use Cytology Codes for Endocervical Brushings

What if the surgeon takes an endocervical -brushing- in addition to or in place of an ECC or biopsy specimen to diagnose a patient following an abnormal Pap?

Do: Assuming the lab processes the sample as a smear, such as a Papanicolaou stain, you should bill an endocervical brushing using a cytopathology code from the 88104-88112 series. You should not use the surgical pathology code (88305) because the specimen is cellular (cytology) rather than tissue (histology), says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc., a pathology business practices company in Simpsonville, Ky., publisher of Pathology Service Coding Handbook. Although you may see an endocervical brushing called a -brushing biopsy,- it is not an 88305 tissue biopsy.

Don-t: Because the pathologist is not -screening- for abnormal cells in an endocervical brushing, you shouldn't use Pap codes such as 88142 (Cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision), according to Padget. This advice accords with guidance given in the July 2006 CAP Today concerning endocervical brushings taken with cervical biopsies.

Do this: Select the proper non-gynecological cytopathology code, based on method, to report endocervical brushings taken by a surgeon for diagnostic pathology exam. For instance, if the lab uses a cell enhancement/concentration thin-layer preparation for the slides, you should report the service as 88112 (Cytopathology, selective cellular enhancement technique with interpretation [e.g., liquid based slide preparation method], except cervical or vaginal).

Watch for: Labs sometimes process endocervical brushing specimens as a cell block alone, without a smear preparation. In that case, report 88305 (Level IV--Surgical pathology, gross and microscopic examination; cell block, any source) for the specimen exam. If the pathologist also examines an endocervical biopsy and/or ECC in addition to the cell block, you would report multiple units of 88305 (one unit for each: cell block, ECC, tissue biopsy).

Clarification: -Brush Up on Cervical Anatomy,- a Reader Question in last month's Pathology/Lab Coding Alert, asked about endocervical vs. cervical brushings. The answer advised using Pap codes because we assumed the reader was referring to a sample sent for screening. -The purpose of the procedure--screening (or follow-up Pap) vs. diagnostic sample--governs the coding of this specimen,- Padget says.

Tip 3: Don't Forget Adjunct Services

The lab might process an endocervical brushing specimen using multiple preparation techniques, and  you should separately code each one, under most circumstances.

For instance: If the lab prepares both cell enhanced/concentrated smears and cell block slides for examination by the pathologist, list both 88112 and 88305 on the claim.

Caution: For cytology cases, Medicare pays for only one type of smear preparation per specimen, according to the National Correct Coding Initiative Policy Manual. That means you should report 88112 alone even if the lab prepares direct or cytospin smears in addition to cell enhanced/concentrated smears for an endocervical brushing specimen.

Opportunity: For other payers, you may be able to list both 88112 and another preparation such as cytospin (88108, Cytopathology, concentration technique, smears and interpretation [e.g., Saccomanno technique]) if the pathologist examines both types of smears.