Pathology/Lab Coding Alert

You know how to select the proper nasal specimen code, but that's not everything you need to know to capture all the pay you deserve. When your pathologist examines nasal specimens, you should also be on the lookout for common ancillary services and make sure you code for those, too.

Nasal specimens often include bone and cartilage: tissue that can require extra work -- and garner extra pay.

"You'll frequently see a decalcification procedure in addition to the pathology exam of bony nasal specimens," says R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark.

Do this: In addition to the primary service, such as nasal turbinate exam (88304, Level III -- Surgical pathology, gross and microscopic examination, bone fragment[s], other than pathologic fracture), you should report +88311 (Decalcification procedure).

Don't assume decalcification: You can't charge +83111 just because you know the specimen includes bone. The pathologist must document the decalcification procedure in the report before you can add the charge.

The pathologist might also order a special stain for a nasal specimen, such as a mucosal biopsy. Special stains help the pathologist identify morphologic detail or microorganisms that basic staining techniques miss.

If the pathologist documents a special stain, you should bill with the appropriate add-on code based on the reason for the stain, as follows:

• +88312 -- Special stains [List separately in addition to code for primary service]; Group I for microorganisms [e.g., Gridley, acid fast, methenamine silver], each

• +88313 -- ... Group II, all other [e.g., iron, trichrome], except immunocytochemistry and immunoperoxidase stains, each.

Tip: Special stains are less common than decalcification for nasal specimens, but you should always be on the lookout for pathologist documentation of the extra service.