Pathology/Lab Coding Alert

New bundles confirm 88387-88388 restrictions.

CPT 2010 opened the door to charges for sterile macroscopic tissue dissection prior to molecular diagnostics tests -- but not prior to microbiology or flow cytometry.

Just to make sure you got the message, the latest version of Medicare's Correct Coding Initiative (CCI) adds 55 edit pairs limiting how you should use these codes:

88387 -- Macroscopic examination, dissection, and preparation of tissue for nonmicroscopic analytical studies (e.g., nucleic acid-based molecular studies); each tissue preparation (e.g., a single lymph node)

+88388 -- ... in conjunction with a touch imprint, intraoperative consultation, or frozen section, each tissue preparation (e.g., a single lymph node) (List separately in addition to code for primary procedure).

CCI version 16.2 became effective July 1. Microbiology Includes Tissue Prep

CPT 2010 states that you should not report 88387-88388 "for tissue preparation for microbiologic cultures."

"That rules out reporting 88387 or +88388 in addition to microbiology cultures from tissue sources," says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha.

CCI 16.2 corroborates that coding advice by bundling 88387 and +88388 as a component of a wide array bacterial culture codes, such as the following:

87070 -- Bacterial culture; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates

87071 -- ... quantitative, aerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool

87073 -- ... quantitative, anaerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool

87075 -- ... any source, except blood, anaerobic with isolation and presumptive identification of isolates.

Non-bacterial cultures count: CCI 16.2 also adds edit pairs to restrict using 88387 or +88388 with cultures for other organisms:

87081 -- Culture, presumptive, pathogenic organisms, screening only

87102 -- Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; other source (except blood)

87109 -- Culture, mycoplasma, any source

87110 -- Culture, Chlamydia, any source

87116 -- Culture, tubercle or other acid-fast bacilli (e.g., TB, AFB mycobacteria) any source, with isolation and presumptive identification of isolates

87118 -- Culture, mycobacterial, definitive identification, each isolate.

Same goes for viral culture: In addition to bacteria, mycobacteria and fungi, CCI 16.2 also confirms that you should not list a viral culture 87250-87255 (Virus isolation; ...) in addition to 88387 and +88388. 88182-88189 Incorporate Manipulation Steps CPT 2010 instructs you to not report 88387-88388 "for tissue preparation for ... flow cytometric studies."

"In other words, you shouldn't report 88387-88388 for getting a tissue specimen ready for flow cytometry tests (88182-88189, Flow cytometry ...)," Slagle says.

For instance: "We might order flow cytometry testing on a bone marrow biopsy specimen to aid in diagnosing leukemia or lymphoma," says R.M. Stainton Jr., MD, president of Doctor's Anatomic Pathology in Jonesboro, Ark.

Prepping the tissue might involve steps such as teasing or cutting tissue, mixing the specimen with an enzyme to disassociate tissue into single cell suspension, and then centrifuging and re-suspending cells for flow cytometry testing.

CCI 16.2 creates new edit pairs for 88387 and +88388 to ensure that you don't use the codes to describe the work involved in any of these tissue prep steps for flow cytometry. The new edit pairs bundle 88387 and +88388 with the following codes:

88182 -- Flow cytometry, cell cycle or DNA analysis

88184 -- Flow cytometry, cell surface, cytoplasmic or nuclear marker, technical component only; first marker

+88185 -- ... each additional marker (List separately in addition to code for first marker)

88187 -- Flow cytometry, interpretation; 2 to 8 markers

88188 -- ... 9 to 15 markers

88189 -- ... 16 or more markers.