Pathology/Lab Coding Alert

CPT 2004 can help

Problem solved. Thanks to CPT Codes 2004 code revisions, labs should no longer get denials for special stain procedures reported with cytopathology or other primary services.
 
Because the old definition for add-on codes 88312 through 88314 included the direction "List separately in addition to code for surgical pathology examination," some payers denied payment for staining services reported with cytopathology or any other procedure besides surgical pathology 88302-88309 (... Surgical pathology, gross and microscopic examination).

CPT 2004 Updates Codes to Include Nonsurgical Specimens

The CPT 2004 code revisions solve the problem by replacing the words "surgical pathology examination" with "primary service." Although CPT only identifies 88312 as a revised code, the revision applies to the entire code family because the change is in the code's common portion:
 

 +88312 - Special stains (list separately in addition to code for primary service); Group I for microorganisms (e.g., Gridley, acid fast, methenamine silver), each
 

 +88313 - ... Group II, all other (e.g., iron, trichrome), except immunocytochemistry and immunoperoxidase stains, each
 

 +88314 - ... histochemical staining with frozen section(s).

"Despite the change, coders should remember that codes 88312-88314 still represent each stain performed, not each slide stained," says Elizabeth Sheppard, HT (ASCP), manager of anatomic pathology at Wake Forest University Baptist Medical Center in Winston Salem, N.C.

Report Separate Stains With Microbiology

Microbiology services sometimes incorporate special stains that CPT lists in the surgical pathology section. For example, the lab may perform a trichrome stain for ova and parasites on a stool sample direct smear. Report the primary service as 87177 (Ova and parasites, direct smears, concentration and identification) and the trichrome stain as 88313. A note following 87177 in the CPT manual directs coders to the appropriate stain code - "For trichrome, iron hemotoxylin and other special stains, use 88313." A similar directional note following 87207 instructs coders, "For complex special stains, see 88312, 88313."
 
Despite the fact that earlier CPT versions directed coders from the microbiology section to the special stain codes in the surgical pathology section, some labs reported denials. "Changing the definitions of 88312-88314 to 'primary service' instead of 'surgical pathology examination' should clarify to payers that labs can use these special stain codes with procedures outside the surgical pathology section," Sheppard says.

Make Sure Lab Certification Is Correct

Even a coding clarification for 88312-88314 won't stop the denial problem if improper lab certification is the culprit. Sometimes payers deny stain codes because they're from the surgical pathology section, and the clinical laboratory has certification for microbiology and parasitology, but not for anatomic pathology. Labs can appeal the denial and ask the payer to add these special stain codes to those allowed under the lab's certification specialty. CPT 2004's change to these codes should strengthen your appeal, because it clarifies that you use the codes in addition to a separate service, not necessarily a surgical pathology service.

Cytopathology Takes Special Stains

In addition to surgical and microbiology sources, labs may also perform special stains for cytopathology slides. For example, the lab may perform an acid-fast bacillus (AFB) stain on a lymph node fine-needle aspiration (FNA) sample submitted from a patient with suspected granulomatous disease.
 
Report the pathologist's examination of the FNA as 88173 (Cytopathology, evaluation of fine needle aspirate; interpretation and report). For the additional AFB stain service, also report 88312, a Group I stain for microorganisms.

Use Iron Stain With Bone Marrow Aspiration

Bone marrow aspiration iron stains represent another legitimate use of special stain codes aside from surgical pathology. For example, a pathologist may perform a bone marrow aspiration, evaluate the smears, and perform and interpret an iron stain for the diagnosis of iron-deficiency anemia, says R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark. Report the bone marrow aspiration as 38220 (Bone marrow; aspiration only) and the evaluation as 85097 (Bone marrow, smear interpretation). And report 88313 for performing and interpreting the iron stain.
 
CPT sanctions reporting 88313 with bone marrow aspiration, as a note following 85097 instructs coders, "For special stains, see 85540, 88312, 88313." Similarly, following the peripheral blood iron stain code (85536), CPT states, "For iron stains on bone marrow or other tissues with physician evaluation, use 88313."

Watch Out for Consultations and Stains

Physicians sometimes ask a pathologist to consult on a previous case. If the pathologist receives tissue and prepares and evaluates slides (as opposed to receiving slides), you should report the service as 88323 (Consultation and report on referred material requiring preparation of slides).
 
"If the pathologist performs special stains on the referred tissue, you should also be able to report the appropriate special stain code, such as 88312-88314," Sheppard says. Because the National Correct Coding Initiative bundles 88323 with 88312-88314, you should report the stain code with modifier -59 (Distinct procedural service) to indicate that you performed a separate service.
 
"We're also concerned that some payers will interpret the wording of the revised stain code definitions, 'list separately in addition to code for primary service,' to disallow using the stain codes with consultation codes because they don't consider a consultation a primary service," Sheppard says.