Pathology/Lab Coding Alert
88161 Bundled With Surgical Pathology A Problem? Not Anymore
Thanks to a National Correct Coding Initiative (NCCI) edit, you may have had problems getting paid when you billed for an intra-operative touch prep and a surgical pathology exam on the same day. But new codes 88333 and 88334 should solve that dilemma.
Problem: Although NCCI Edits allowed you to bill 88329 and 88161 together, a separate edit added in October 2003 bundled 88161 with surgical pathology codes 88304-88309 (Levels III-VI, surgical pathology, gross and microscopic examination). The edit meant that Medicare might deny payment of an intraoperative touch prep performed on the same date as a pathology evaluation.
Because NCCI allowed you to override the edit with modifier 59 (Distinct procedural service), pathologists were still able to bill for both procedures, in many cases.
For instance: If a pathologist intraoperatively evaluated touch preps from four separately identified surgical margins of a breast lumpectomy and later examined and diagnosed the breast tissue, you could report 88307 (... breast, excision of lesion, requiring microscopic evaluation of surgical margins) for the pathology exam, 88329 for the intraoperative consultation, and four units of 88161-59 for the touch preps.
"But we had to pay careful attention to documenting that the touch preps were distinct services, and we had to use modifier 59 to get paid for 88161 and 88307 together," says Ernest J. Conforti, MSHS, SCT (ASCP) MT, assistant director of anatomic pathology operations at North Shore-Long Island Jewish Health System, headquartered in Great Neck, N.Y.
Solution: Now you would report the preceding scenario as 88333 for the first margin touch prep, 88334 x 3 for the other three margin touch preps, and 88307 for the pathology exam. "There's no need for modifier 59 since there is currently no NCCI edit bundling 88307 with 88333 or 88334," Conforti says.
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