Pathology/Lab Coding Alert

When pathologists perform special stains apart from a primary service, you often couldn't get paid - until now. CPT 2010 changes all that by removing the add-on status from codes 88312 (Special stains; Group I for microorganisms [e.g., Gridley, acid fast, methenamine silver], including interpretation and report, each) and 88313 (... Group II, all other [e.g., iron, trichrome], except immunocytochemistry and immunoperoxidase stains, including interpretation and report, each). The revised code definitions delete the text "[List separately in addition to code for primary service]" and add the text "including interpretation and report, each."

Because special stain codes had the + designation in CPT, most payers denied the claim if you didn't bill the stain with another procedure such as surgical pathology or cytopathology exam. "As long as special stains were add-on codes, you had to report them with the primary service on the same date," explains Pamela Biffle, CPC, CPC-I, CCS-P, ACS-DE, principal for PB Healthcare Consulting and Education in Fort Worth, Texas.

As CPT instruction states, "Add-on codes are always performed in addition to the primary service or procedure and must never be reported as a stand-alone code."

Sometimes pathologists perform and interpret special stains on a tissue specimen apart from a primary service. "For instance, a lab at a smaller hospital might perform basic histology but send out any special stains to us," says R.M. Stainton Jr., MD, president of Doctor's Anatomic Pathology, an independent pathology laboratory in Jonesboro, Ark.

Example: A rural hospital sends your lab a lymph node with granuloma and requests acid-fast bacillus (AFB) and periodic acid-Schiff (PAS) stains. Your lab prepares the special stains and your pathologist interprets them.

Solution: The AFB and PAS stains are both microorganism stains, so you should bill 88312 x 2. You should not bill for the surgical pathology lymph node exam (88305, Level IV -- Surgical pathology, gross and microscopic examination, lymph node, biopsy)because the pathologist at the other institution performs that service. You also should not bill for a consultation (such as 88323, Consultation and report on referred material requiring preparation of slides). The hospital lab did not send previously interpreted material from the lymph node biopsy and did not request a consultation.

"We've always had problems with payers not wanting to pay for these stains because we're not billing it with a primary service, such as a consultation or a surgical pathology exam," Stainton says.

Problem solved: Because CPT 2010 removes the + from 88312 and 88313, meaning that they are no longer add-on codes, you should start receiving payment for stand-alone special stain charges.