Pathology/Lab Coding Alert
Did You Know Frozen Sections Break the Rules?
You keep reminding yourself that you can't code per block. And you're right - for cytopathology and surgical pathology with certain ancillary services. But you're not right if you're talking about frozen sections. 'Frozen Section' Means Consultation During Surgery The frozen section codes are part of the code family beginning with CPT 88329 (Pathology consultation during surgery). Report this code when the surgeon asks the pathologist to consult on a patient during surgery, but the pathologist performs a gross-only consultation rather than examining frozen tissue sections. Code per Block, but Beware the Specimen If the pathologist interprets frozen sections from multiple blocks prepared from the same specimen, you should report both codes 88331 and 88332. Use 88331 to report the first block from a given specimen. Regardless of the number of sections, you should report 88331 when the pathologist examines sections from only one block.
In fact, you do code frozen sections per block. To complicate matters, you even code the blocks differently depending on whether they are from the same or different specimens.
The frozen section codes are part of the same family:
The codes describe not just the frozen section preparation but also the pathologist's interpreting and reporting results to the surgeon during surgery.
Do not report these codes when the lab prepares frozen tissue blocks and sections as part of a different procedure that does not involve a consultation during surgery, such as 88314 (Special stains [list separately in addition to code for surgical pathology examination]; histochemical staining with frozen section[s]). Code 88314 includes the frozen section preparation and interpretation for studies such as muscle tissue ATPase and NADH staining for the diagnosis of muscle atrophy or dystrophy, says Elizabeth Sheppard, HT (ASCP), manager of anatomic pathology at Wake Forest University Baptist Medical Center in Winston Salem, N.C.
"Because 88329-88331 are part of the same code family, sharing the same definition preceding the semicolon, you should not report either 88331 or 88332 with the parent code (88329) for the same specimen," says Laurie Castillo, MA, CPC, CPC-H, CCS-P, president of Professional Coding and Compliance Consulting in Manassas, Va. If the pathologist prepares and interprets frozen sections during surgery, the code (such as 88331) includes the consultation service described by 88329. The National Correct Coding Initiative edits confirm this bundling. "Only if the pathologist performs a gross consult on one specimen and a frozen section consult on a different specimen should you report 88329 with the frozen section codes. Then you'd have to use modifier -59 (Distinct procedural service) to override the edit," Castillo says.
If the pathologist prepares and interprets frozen sections from a second block from the same specimen, report 88332 in addition to 88331 for the first block. For multiple additional blocks from the same specimen, report each as an additional unit of 88332.
But what if the surgeon asks for a frozen section consultation on two different specimens? "For each specimen, you have to start with 88331 for the first block, and add 88332 for each subsequent block," Castillo says. You can't just count up blocks: You could have two scenarios with the same number of blocks but completely different coding. Let's look at an example of that:
Scenario 1: A surgeon requests a pathology consultation during surgery for a large ovarian mass. The pathologist prepares and evaluates frozen section slides from three blocks and reports the results to the surgeon. Report this service as 88331 for the first block, and 88332 x 2 for the additional two blocks.
Scenario 2: A pathologist consults on the margins of a bowel resection, preparing two blocks for frozen section diagnosis. Later that day, the surgeon calls the pathologist back to consult on a separate margin for the same patient, requiring one block with frozen sections. Report this service as 88331 and 88332 for the first margin consult. Also report 88331 for the block the pathologist prepared and examined for the second surgical margin consultation.
Scenario 3: The surgeon requests an intra-operative consultation on three distinct skin lesions. The pathologist prepares and evaluates frozen sections from one block for each lesion. Report this service as 88331 x 3.
Pathology/Lab Coding Alert
- Don't Let NCCI 9.3 Surgical Pathology Edits Stop You
You can still report separate cytopathology You shouldn't be reporting the CPT 88160 family for [...] - You Can Get NCCI Edits Free Online
After years of paying to learn about new coding restrictions CMS has placed on your [...] - Learn NCCI's Latest Bundles - and How to Override Them
Heads up for a new list of codes that Medicare says you can't report together [...] - You Be the Coder:
Medicare Changes Fecal Leukocyte Code
Question: We used to bill Medicare for fecal leukocyte exams using G0026, but that code [...] - Here's How to Improve Your Surgical Pathology Pay
Specimens, blocks, smears or stains - just what is the unit of service for pathology [...] - Did You Know Frozen Sections Break the Rules?
You keep reminding yourself that you can't code per block. And you're right - for [...] - Reader Question:
Separate Bone Marrow Interpretation, Collection
Question: A patient with myeloma was having an unrelated knee replacement surgery. During the operation, [...] - Reader Question:
Use HPV Diagnosis as the Reason for the Test
Question: Our lab performed a screening thin-layer preparation Pap smear ordered for a low-risk patient. [...] - Reader Question:
Bethesda and ICD-9-CM Still Don't Match
Question: I've heard that we should report Bethesda's Pap categories of
ASCUS and ASCH using [...]
