Pathology/Lab Coding Alert

When your pathologist performs sterile macroscopic dissection to prep tissue for molecular diagnostics tests, you didn't have a way to capture the service -- until now. Take advantage of this new payment opportunity by learning when you can and can't use the 2010 codes, how to document the service, and what you need to know for correct billing.

CPT 2010 introduces two new codes to describe surgical pathology tissue prep for certain ancillary tests:

• 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).

"These codes describe macroscopic examination and processing of the target tissue such as a sentinel lymph node for non-microscopic molecular analysis," says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc. and publisher of the Pathology Service Coding Handbook, in The Villages, Fla.

The processing includes work such as "dissecting an appropriate portion of the tissue away from the main specimen, and cutting and labeling thin sections under sterile conditions," Padget explains.

You should not report 88387 or +88388 when the pathologist retrospectively selects a tissue block for molecular analysis based on initial slide review.

You have to think "pre-analytic" and "macroscopic" when deciding whether to use one of these codes, Padget says. "Early indications are that some labs are using them incorrectly -- if you're selecting tumor cells from paraffin embedded material or cutting sections from a block for send-out, that's not covered by 88387 or +88388."

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

"That rules out reporting 88387 or +88388 as prep for any microbiology codes or 88182-88189 (Flow cytometry )", says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha.

The work involved in prepping tissue for microbiology cultures or flow cytometry studies are part of those respective codes.

Because the code descriptors specifically reference "non-microscopic analytical studies" you should not report 88387 or +88388 for tissue prep for special stains or immunohistochemistry-based tumor morphometry analysis, according to Padget.

In other words, don't report 88387-88388 when the pathologist preps tissue solely for any of the following microscopy-based ancillary studies:

• Special stains (88312-88319)
• Immunohistochemistry (IHC) (88342, 88360-88361)
• Immunofluorescent study (88346-88347)
• Electron microscopy (88348-88349).

You should report 88387 or +88388 for special tissue prep for "nucleic-acid based molecular studies," according to the code definition. That would include any codes from the range 83890-83913 (Molecular diagnostics ).

"The definition allows you to use 88387-88388 when the pathologist performs a macroscopic exam and dissection to prepare tissue for molecular diagnostics tests such as polymerase chain reaction (PCR)," Slagle says.

For instance: The pathologist might process a sentinel lymph node biopsy and provide distinct sterile macroscopic examination and sectioning for T or B clonality evaluation, according to Sophia Hauxwell,MT-ASCP, laboratory scientist in the University of Nebraska Medical Center Molecular Diagnostics Laboratory in Omaha.

"You need to be discriminating here," Padget warns.Don't use 88387-88388 to separately charge for the conventional gross exam/dissection that takes place with all tissue specimens prior to microscopic examination. And don't automatically bill the codes every time you order a molecular study. "The pathology report must document a distinct macroscopic exam to identify tumor-containing areas, with dissection of thin sections, all under sterile conditions. This level of work is above and beyond the usual work that occurs at the grossing bench," he explains.

What about FISH? "Our understanding of 88387-88388 would allow using the codes when the pathologist preps tissue for fluorescence in situ hybridization (FISH)," Slagle says. "FISH meets the criteria of non-microbiology, non-flow cytometry testing involving nucleic acids."

Warning: "I agree that FISH should qualify because it's clearly a DNA or RNA test," Padget says. But without an automated imager, you'll use a microscope to see the probe staining, which might mean FISH doesn't pass the "non-microscopic" test, he cautions. "As long as you fulfill other criteria for using 88387 or +88388, I'd report one of those codes with a manual FISH test until I'm told otherwise by an authority like the AMA or CMS," Padget concludes.

Avoid cytogenetics: "I don't think traditional cytogenetics fits the requirements for use with 88387-88388," Padget says. Although cytogenetics testing as an ancillary service to surgical pathology involves DNA or RNA, it also typically involves microscopic examination of tissue cultures.

The unit of service for codes 88387 and +88388 is "each tissue preparation." That means you can list two units of 88387 or +88388 if the pathologist separately preps two distinct sentinel lymph nodes for molecular testing.

No TC billing: "Although codes 88387 and +88388 have distinct technical components under the Medicare physician fee schedule, no authoritative source has indicated that you can bill a separate technical fee when a pathologist doesn't also perform the professional component," Padget says.