Pathology/Lab Coding Alert

88312 unit change could earn you $107 or more.

The American Medical Association (AMA) has changed its long-standing rule for reporting special stains per specimen, instead aiming at the "block" as the unit of service. With a series of text notes in CPT® 2012, the AMA closes the gap on a troubling payer discrepancy in how to code for these services.

"The AMA now advises that the unit of service for special stains focuses on the block, rather than the specimen, which comports with Medicare policy," says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc. and publisher of the Pathology Service Coding Handbook, in The Villages, Fla.

You learned about key changes to special stain codes -- such as the new designation for Group III stains -- in Pathology/Lab Coding Alert Volume 12, Number 12 "88312-88319: Revamp Your Special Stain Coding for Accurate Claims." Now let our experts guide you through the unit-of-service change for these codes.

Look to Revised-Code Text Notes

CPT® 2012 makes the following changes to special stain codes, and adds the associated text notes regarding the unit of service (strikethrough denotes deleted words, underline denotes added text):

• 88312 -- Special stains including interpretation and report; Group I for microorganisms (e.g., Gridley, acid fast, methenamine silver), including interpretation and report, each

• 88313 -- Group II, all other (e.g., iron, trichrome), except immunocytochemistry and immunoperoxidase stain for microorganisms, stains for enzyme constituents, including interpretation or immunocytochemistry and report, each immunohistochemistry

(Report one unit of 88313 for each special stain, on each surgical pathology block, cytologic specimen, or hematologic smear)

• + 88314 -- histochemical staining with on frozen section(s), including interpretation and report tissue block (List separately in addition to code for primary procedure)

(Report one unit of 88314 for each special stain on each frozen surgical pathology block)

• 88319 -- Group III for Determinative histochemistry or cytochemistry to identify enzyme constituents, each

(For each stain on each surgical pathology block, cytologic specimen, or hematologic smear, use one unit of 88319)

Each stain: For codes 88312-88319, the text notes unanimously declare that you should use one unit of the code for each special stain. "That's no different than how we've always reported special stains: listing one unit of the appropriate code for each distinct special stain," says R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark.

Stain what? The question is: Each special stain on what? The answer used to be each special stain on a surgical pathology specimen -- unless you were coding for a Medicare beneficiary post Oct. 2009, in which case the answer was each special stain on a surgical pathology block. That direction came from CMS' Version 15.3 of the NCCI Policy Manual, and referred to codes 88312 and 88313.

Stain this: Now CPT® 2012 clarifies that you should separately report the appropriate special stain code 88312, 88313, or 88319 for each special stain on one of the following:

• Surgical pathology block
• Cytologic specimen
• Hematologic smear.

"That's a change from how we've reported special stain codes in the past, when we listed one unit of the code for each unique stain on a given specimen, not block," Stainton says.

The notes also clarify that you can report the stains with specimens other than surgical pathology tissue, such as cytology. Using the special stain codes with specimens other than 88302-88309 (Level X, Surgical pathology, gross and microscopic examination ...) had been a source of denials for some payers in the past.

For +88314, you should report one unit of the code for each special stain on each frozen surgical pathology block.

Caution: "Don't forget that you shouldn't list +88314 for routine intraoperative frozen section stains, such as hematoxylin and eosin (H&E) or toluidine blue," Padget says. "A stain used to highlight basic cell architecture so that it can be evaluated under the microscope--a 'routine' stain--is never separately chargeable."

Expect More Pay

Because you can now code one special stain unit for a surgical pathology block as opposed to a surgical pathology specimen, you can expect more pay for your work, in some cases.

For instance: The pathologist processes a lung wedge resection in two paraffin tissue blocks and notes granulomas on H&E stained slides. He performs an acid fast bacillus (AFB) stain on slides from each block to evaluate the tissue for possible tuberculosis infection.

Old way: Under past CPT® rules, you would report one unit of 88312 for the single lung wedge resection specimen and receive $106.69 (2011 Physician Fee Schedule national amount, conversion factor 33.9764).

New way: Under 2012 CPT® rules, you would report two units of 88312 for two tissue blocks from a single lung wedge resection specimen and receive twice the pay: $213.38.