Pathology/Lab Coding Alert

Don't mistake 88106-88107 for 88112

Not all filtration methods are created equal, and you need to know the difference if you-re going to capture the correct cytology payment, from $44.34 for simple filter method to $70.11 for monolayer technique.

Altered Definition Distinguishes Codes

Because non-gynecological liquid cytology (88112, Cytopathology, selective cellular enhancement technique with interpretation [e.g., liquid-based slide preparation method], except cervical or vaginal) often involves filter-transfer techniques, some coders have confused the method with the other cytology filtration codes 88106 and 88107.

-You have to select the non-gyn cytology code based on the definition that most closely matches the method your lab uses to process and examine the specimen,- says Kathy L. Grant, PhD, CT (ASCP), technical manager, cytopathology, Duke University Health System, and anatomic pathology manager, Duke Raleigh Hospital, in Durham, N.C.

Code change: CPT 2007 changes the definitions of 88106 and 88107 to emphasize that the lab method involves only simple filtration, not the more complex filter transfer technique used in monolayer preparations earning 88112. The codes change by the addition of the word -simple- to the definitions:

- 88106 -- Cytopathology, fluids, washings or brushings, except cervical or vaginal; simple filter method with interpretation

- 88107 -- Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears and simple filter preparation with interpretation.

-Preparing cytopathology specimens with simple filtration such as Millipore filter is an older technology and not commonly used any more,- Grant says.

Tip: -Use 88106 if the pathologist examines only smears prepared after filtering the specimen, and use 88107 if the pathologist examines both direct smears and smears following filtration,- says Elizabeth Sheppard, HT (ASCP), marketing manager for Ventana Medical Systems in Tucson, Ariz.

Do this: Avoid 88106 and 88107 for methods that involve filter concentration and enhancement of cytological material followed by transfer to a glass slide for further processing and evaluation -- instead, use 88112.
 
In fact, CPT 2007 adds this note following 88107: -For nongynecological selective cellular enhancement including filter transfer techniques, use 88112.-

Study 3 Clinical Examples

Use the following examples to highlight the difference between 88106, 88107 and 88112.

1. Lab personnel vacuum wash a bronchoalveolar lavage (BAL) specimen on a cellulose filter and direct smear filtered cells onto a slide for pathologist examination and report. List this service as 88106.

2. For the same service as example 1, except the pathologist also examines direct smears from the BAL, report 88107. This code includes both the direct and filtered smears.

3. The lab processes cerebrospinal fluid using centrifugation and filtration for cellular enhancement before applying a monolayer suspension to a slide for evaluation using ThinPrep imaging system. Report the service as 88112.

Don't miss: Unlike surgical pathology, in which the specimen determines the code, the method determines the code for cytology. -Depending on the lab method, you can use any of the non-gyn cytology codes 88104-88112 for a given specimen,- Sheppard says.

NCCI Says Don't Unbundle

If your pathologist examines non-gyn cytology slides from the same source using two methods, such as direct smear (88104, Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation) and filter preparation (88106), you should not report both codes to Medicare and some other payers. Instead, you should select the most extensive procedure code, which in this case is 88106.

The National Correct Coding Initiative (NCCI) bundles each code in the series 88104-88112 with all the other codes in the series. The NCCI Policy Manual states, -for a given [cytopathology] specimen, only one code from a group of related codes describing a group of services that could be performed on a specimen with the same end result (e.g., 88104-88112, 88142-88143,88150-88154, 88164-88167, etc.) is to be reported.-

NCCI instruction clarifies that you can override the edit pairs that prohibit reporting these codes together only if the lab performs the different cytopathology services on two separate specimens. In that case, you can override the edit pair by using modifier 59 (Distinct procedural service).

Opportunity: Although Medicare clarifies that you cannot separately report two cytopathology methodologies for the same specimen, even when medically necessary, you should check with your non-Medicare payers to see if they still allow you to bill separately.