CPT 2001 contains many changes for pathology/laboratory coding. The section includes 57 new, 66 revised and 17 deleted codes, as well as some changes to the narrative instructions.
pathology Coder should learn the details of the new and changed codes to make sure they receive the appropriate reimbursement.
Sentinel Lymph Node, FNA and Frozen Section Coding Clarification
Probably the most important changes for anatomic pathology in CPT 2001 involve coding for sentinel lymph nodes, fine needle aspiration (FNA) and frozen sections, says Laurie Castillo, MA, CPC, CPC-H, CCS-P, a member of the national advisory board of the American Academy of Professional Coders (AAPC) and president of its Northern Virginia Chapter.
Sentinel lymph node has been added to the specimen list for 88307 (level V surgical pathology, gross and microscopic examination) in CPT 2001. Although sentinel lymph node biopsy requires more extensive study for occult metastases, there previously was no way to capture the increased level of service, Castillo says. In fact, some coders were hesitant to code separately for the sentinel node at all, even as 88305 (level IV lymph node, biopsy), because the procedure is often carried out for a patient undergoing a radical mastectomy (88309, level VI breast, mastectomy - with regional lymph nodes), which lists the nodes as included in the specimen. The addition of the sentinel lymph node to 88307 makes it clear that the sentinel node is considered a separate specimen, and should be coded separately from any other surgical specimen, Castillo says.
Codes for FNA were modified in CPT 2001 to clarify which portion of the procedure is represented by each code. The words with or without preparation of smears were removed from 88170 (fine needle aspiration; superficial tissue [e.g., thyroid, breast, prostate]), 88171 (... deep tissue under radiologic guidance) and CPT 88172 (cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen[s]).
Codes 88170 and 88171 are used to report the aspiration of fluid or tissue through the needle, which may or may not be carried out by the pathologist, Castillo explains. Code 88172 describes the pathologists immediate evaluation of the aspirate to determine if the specimen is adequate, or if more cells must be aspirated. The final interpretation and report is coded 88173. A pathologist may report the three codes together if all three services are provided: 88170 or 88171 for removing the specimen, 88172 to determine adequacy, and 88173 for interpretation.
A change in wording for frozen sections clarifies another issue that has confused coders in the past. The words first tissue block were added to 88331 (pathology consultation during surgery; first tissue block, with frozen section[s], single specimen.) This makes it [...]
