Pathology/Lab Coding Alert

"List separately" instruction clarifies coding for additional slides

If you get bogged down in how to report multiple frozen sections and/or touch preps that your pathologist performs aspart of an intraoperative consult, CPT 2011 has a gift for you.

By adding the parenthetic phrase, "List separately in addition to code for primary procedure," CPT 2011 revises the following codes to provide greater clarity:

• 88332 -- Pathology consultation during surgery; each additional tissue block with frozen section(s) (List separately in addition to code for primary procedure)
• 88334 -- ...; cytologic examination (e.g., touch prep, squash prep), each additional site (List separately in addition to code for primary procedure).

The revision shouldn't change how you code, if your pathology practice has been using the codes correctly.

However: "If you've been confused about how to bill for multiple frozen sections or multiple touch preps, or even a combination of intraoperative frozen sections and touch preps, the code revision should help clear up any potential misinterpretation," says Melissa Sinclair, CPC, an independent consultant based in Denver.

Put 88332 and 88334 in Context

The two revised codes, 88332 and 88334, are part of a larger code family that also includes the following:

• 88329 -- Pathology consultation during surgery››
• 88331 -- ... first tissue block, with frozen section(s), single specimen
• 88333 -- ... cytologic examination (e.g., touch prep, squash prep), initial site.

Document intraoperative: "During surgery" is the key to codes in the 88329-88334 family. "When performing an intraoperative consultation, the pathologist provides immediate feedback to the surgeon," Sinclair explains. "The surgeon can then use the pathologist's findings to help determine the appropriate course of action while the patient is still on the operating table."

Watch for 'Gross Only'

Report 88329 if the intraoperative pathology consultation involves only a gross tissue examination. "Sometimes we don't need to do a microscopic exam, such as a bowel resection that includes enough normal mucosa to ensure clear margins on gross inspection," says R.M. Stainton, Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark. Gross included: Don't separately report 88329 for the gross exam in addition to any frozen section or touch prep codes for the same specimen. Because 88329 is the parent code, the subsequent codes include the base 88329 service.

Multiple Frozens -- Do This:

The pathologist often examines multiple frozen sections to arrive at an intraoperative preliminary tumor evaluation. Correctly using codes 88331 and 88332 requires that you understand the method and the unit of service.

Know the parts: The pathologist selects part of the surgical specimen for the lab to process by flash freezing into one or multiple blocks -- these are tissue blocks. For each block, the pathologist may examine multiple slides of thin sections cut from the frozen tissue block -- these are frozen sections.

The unit of service for 88331 and 88332 is the frozen tissue block, not the specimen or the frozen section slide. Caveat: You have to keep track of specimens, too, because counting blocks starts over every time you encounter a new specimen.

Code first: Use 88331 to report the pathologist's evaluation during surgery of any number of frozen sections from the first (or only) tissue block from a specific specimen.

Code subsequent: If the pathologist examines frozen section slides from an additional frozen tissue block(s) from the same specimen, use 88332 for a second or subsequent tissue block from the same specimen.

"Adding the phrase 'List separately in addition to code for primary procedure' to 88332 makes it clear that you should be reporting both 88331 and 88332 if the pathologist examinesmultiple frozen section blocks from the same specimen," Sinclair says.

Repeat for each specimen: If the pathologist consults on a separate specimen later in the same surgery, such as a different margin resection, you should repeat the same coding sequence.

"Code an additional 88331 for the first block of the new specimen and additional 88332(s) for any subsequent block(s)," Sinclair says.

Numerous Touch Preps -- Do This:

Sometimes the pathologist will use a touch or squash preparation to evaluate tissue during surgery. "The process involves pressing a glass slide against the cut surface of the specimen, then staining and placing a cover slip on the slide," Sinclair says.

Site parallels block: Similar to frozen sections, CPT provides two codes for intraoperative touch preps: 88333 and 88334. For touch preps, however, the unit of service is the site, not the block (as it is for frozen sections).

Code first: Use 88333 to report the pathologist's evaluation during surgery of the touch prep slide(s) from the first site of an excision specimen.

Code subsequent: If the pathologist examines touch prep slides from additional sites of the same specimen, use 88334 for a second or subsequent touch prep site. By adding the phrase 'List separately in addition to code for primary procedure' to 88334, CPT 2011 clarifies that you should use 88333 and 88334 together in this case.

Repeat as necessary: If the pathologist consults on a separate specimen later in the same surgery, such as a different lymph node, you should repeat the same coding sequence. By adding the phrase 'List separately in addition to code for primary procedure' to 88334, CPT 2011 clarifies