Pathology/Lab Coding Alert

4 tips simplify your non-gyn cytology coding.

Just remember four specific rules about coding non-gynecological (non-gyn) cytology specimens and you won't miss the code that CPT® 2012 deleted: 88107 (Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears and simple filter preparation with interpretation).

To see why you shouldn't expect to lose much pay this year due to the code deletion, make sure you're reporting the remaining non-gyn cytology codes correctly based on the following four tips.

Tip 1: Know the Specimen Source

Non-gyn cytopathology conventionally refers to cytology specimens that are not cervical or vaginal smears (Pap tests) and are not fine needle aspiration (FNA) specimens.

In other words, non-gyn cytology specimens include washings (such as bladder), brushings (such as bronchial), body fluids (such as urine) and body-fluid aspirates (such as cyst, pleural, spinal, peritoneal), and "other source" (such as sputum, nipple discharge, and touch preps).

If you're dealing with any of these specimens, you should report one of CPT's non-gyn cytopathology codes. Choosing the correct code depends on following the next tip.

Tip 2: Method Leads Non-Gyn Code Selection

You should report most non-gyn cytopathology services based on the type of slide preparation using one of the following codes, regardless of the non-gyn specimen source:

• 88104 -- Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation
• 88106 -- ... simple filter method with interpretation
• 88108 -- Cytopathology, concentration technique, smears and interpretation (e.g., Saccomanno technique)
• 88112 -- Cytopathology, selective cellular enhancement

In other words, whether you're coding for a urine specimen or bronchial alveolar lavage (BAL) specimen, you would select 88104 for a direct smear, or one of the other codes depending on how the lab prepares the specimen slides.

Exception: If you're dealing with direct smears from "other source" specimens, such as sputum, nipple discharge, or touch prep, choose one of the following codes:

• 88160 -- Cytopathology, smears, any other source; screening and interpretation
• 88161 -- ... preparation, screening and interpretation
• 88162 -- Cytopathology, smears, any other source; extended study involving over 5 slides and/or multiple stains

Warning: Don't use 88162 to report more than five slides from a fluids/washings or brushings source. "You should use codes in the 88160-88162 family only for narrowly defined cell sources -- other than gynecological cells or fluids, washings or brushings," says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha.

Tip 3: Capture Multi-Code Opportunity

What if your lab processes a single specimen with multiple slide preparations, such as a cerebrospinal fluid (CSF) specimen processed and interpreted as both direct and cytospin (concentrated) smears?

According to CPT Assistant® January 1998, you can separately report certain combinations of cytology preparations when medically necessary, such as 88104 and 88108 for the preceding example. The multi-code option isn't available for all cytopathology preparations: For instance, a CPT® text note states, "Do not report 88112 with 88108."

Caution: CMS restricts reporting multiple cytology preparations, so you'll need to follow "Tip 4" when billing Medicare or other payers who follow Correct Coding Initiative (CCI) bundling rules.

88107 change: As it deleted 88107 (a code for both direct and simple filter smears from the same specimen), CPT® 2012 added a new text note that won't let you report those preparations together: "Do not report 88106 in conjunction with 88104." Don't let the CPT® 2012 addition of another text note confuse you: "88107 has been deleted. To report smears and simple filter preparation, see 88104, 88106."

"Taken together, these two notes imply that you should select just one code -- 88104 or 88106 -- if you prepare direct smears and simple filter smears from the same specimen," says William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

The Medicare Physician Fee Schedule national reimbursement amount (conversion factor 34.0376) is $67.73 for 88104, versus $72.84 for 88106 (global service, including technical and professional components), so reporting 88106 would be to your advantage.

Tip 4: Accommodate Bundling Rules

Beyond the restrictions mentioned above that CPT® placed on reporting non-gyn cytopathology procedures together for a single specimen, CMS created further restrictions via the CCI edits and Policy Manual:

"A cytopathology preparation from a fluid, washing, or brushing should be reported using one code from the CPT code range 88104-88112. It is inappropriate to additionally report CPT codes 88160-88162 because the smears are included in the codes referable to fluids (or washings or brushings) and CPT codes 88160-88162 reference 'any other source' which would exclude fluids, washings, or brushings."

Bottom line: For Medicare or payers who follow CCI bundling rules, select only the single most appropriate code from the range 88104-88112 or 88160-88162 for a single non-gyn (and non-FNA) specimen. If you're billing for two different cytology preparations for two different specimens, you'll need to use modifier 59 (Distinct procedural service) to override the edit pair.