Pathology/Lab Coding Alert

Frozens are 'first' -- touch preps are 'additional.'

You've just read how CPT 2011 helped clarify reporting multiple intraoperative frozen section blocks and touch prep sites, but what if the pathologist evaluates frozen sections and touch preps during an intraoperative consultation on the same specimen?

Frozens and Touch Preps Together -- Do This:

CPT provides a text note that instructs you how to code both services: "For intraoperative consultation on a specimen requiring both frozen section and cytologic evaluation, use 88331 [Pathology consultation during surgery; first tissue block, with frozen section(s), single specimen] and 88334 [... cytologic examination (e.g., touch prep, squash prep), each additional site (List separately in addition to code for primary procedure]."

Here's how: Remember, CPT says to use the "first" frozen section code -- 88331 -- and the "each additional site" touch prep code -- 88334. "You shouldn't use both 'initial site' codes -- 88331 and 88333 (...cytologic examination [e.g.,touch prep, squash prep], initial site) -- because only one site from the same specimen can be 'first'," explains Ernest J. Conforti, MS, MBA, SCT(ASCP)MT, director of patient financial services for North Shore-Long Island Jewish Health System, headquartered in Great Neck, N.Y.

CPT 2011 change: Adding the "List separately ..." phrase to88334 supports the coding injunction to use 88331 and 88334 together for frozens and touch preps instead of using 88331 and 88333.

Watch for CCI Edits

Despite clear CPT instruction to use 88331 and 88334 together when the pathologist intraoperatively evaluates a specimen requiring both frozen section and cytologic evaluation, you might encounter some problems with this coding.

Roadblock: CMS' Correct Coding Initiative (CCI) bundles 88331 and 88334 as a column 1/column 2 edit pair, meaning that you should not report the two codes together. Although listed with a modifier indicator of "1," which means you can override the edit pair, you need to understand when you can legitimately do so.

Work around: Remember your units of service -- it is not the specimen for frozen sections or touch preps. Rather, it is the block or the site. "If the pathologist evaluates a single specimen using frozen sections from one site, such as the primary tumor, and touch preps from a different site, such as a surgical margin, you can override the 88331-88334 edit using modifier 59 (Distinct procedural service)," Conforti says. You'll have to append modifier 59 to 88334 to override the CCI edit pair.

Document different sites: To justify 88331 and 88334 charges for a single specimen, you must provide complete and unambiguous documentation. The pathologist must uniquely identify the site subjected to frozen section and each margin or other site used for touch preps.