Pathology/Lab Coding Alert

3 groups clarify parallel services.

Prepare for a CPT® special-stain overhaul starting Jan. 1, 2012, but don't expect big changes to how you code your work.

Although revisions impact every special stain code in the range 88312-88319, they're more minor repair than major revamp. See the changes for yourself with the chart on page 82.

'Interpretation and Report' is Primary

Most, but not all, of the CPT® 2011 special stain codes include the phrase "including interpretation and report" somewhere in the code definition.

CPT® 2012 moves the phrase to a position preceding the semicolon and includes it in every special stain code definition.

Identify code family: CPT® 2012 creates a true code family of the code range 88312- 88319, because each subsequent code indents under 88312 (Special stain including interpretation and report; Group I for microorganisms [e.g., acid fast, methenamine silver]).

Welcome Group III

Notice that starting Jan. 1, 88319 (... Group III for enzyme constituents) will designate enzyme constituents as "Group III" stains. The change shouldn't alter how you use the code -- 88319 has always described stains for enzyme constituents.

"Prior to this change, CPT® classified special stains only as 'Group I' or Group II,'" says R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark.

Starting Jan. 1, Group III stains join Group I stains that identify microorganisms, and Group II stains that identify all "other."

Accommodate Group III: Notice that CPT® 2012 provides a change to 88313 (... Group II, all other (e.g., iron, trichrome), except stain for microorganisms, stains for enzyme constituents, or immunocytochemistry and immunohistochemistry) to clarify that "other" now represents non-Group I and non-Group III stains, as well as non-immunostains (88342, Immunohistochemistry (including tissue immunoperoxidase), each antibody).

Adding the "Group III" terminology and eliminating method-specific descriptors (Determinative histochemistry or cytochemistry) are the primary changes to 88319.

Stain example: "We occasionally perform dual esterase stain, which we report with 88319," says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha. Labs may use an esterase stain for muscle biopsies, for instance. The code selection should not change under CPT® 2012 .

Beware Unit of Service

Special stain code revisions remove the word "each" from the definitions. Does that mean you should no longer separately code each special stain?

No. The 2011 definitions stated "special stains ... each," but the new definitions state, "special stain" -- singular. The effect is the same in how you should use these codes -- one unit per special stain per specimen.

Caveat: CMS' Version 15.3 of the NCCI Policy Manual, effective Oct. 1, 2009, introduced instruction allowing you to bill Medicare payers using 88312 and 88313 per block, rather than per specimen. Your lab compliance officer should work with payers to establish the accepted unit of service for special stain billing: per stain for each block, or per stain for each specimen.

Watch +88314 change: CPT® changes the +88314 descriptor from "histochemical staining with frozen section(s)," in 2011 to "histochemical stain on frozen tissue block" in 2012. The new definition should not change the unit of service.

Rather, the updated code definition better describes the 88314 procedure -- staining slides from frozen tissue blocks rather than from standard paraffin blocks. Labs sometimes use this procedure for specimens such as muscle, because fixatives in standard paraffin imbedding may interfere with certain cellular features critical to diagnosis.