Pathology/Lab Coding Alert

When material is referred from another pathologist or facility, the use of CPT codes 88321-88325 (consultation and report on referred material) may seem straightforward. But these codes often are used improperly by pathologists and coders, according to Peggy Slagle, CPC, billing compliance coordinator for the Department of Pathology and Microbiology at the University of Nebraska Medical Center in Omaha, Neb.

This is a big issue for us, reports Slagle, because as a university lab, we do a lot of consultations and often receive material from other laboratories for deemed opinions. Although the specimen is the unit of service for most surgical pathology codes, accession is the unit of service for consultation codes 88321-88325.

Code Consultations Per Accession

Whether the lab receives referred slides (88321) or referred tissue requiring preparation of slides (CPT 88323 ), the service should be billed on a per accession basis. Accession simply means an item added. But for a pathology lab , does that mean each slide or each box of slides? Does it mean each container of tissue? Is an accession all material relating to a patient that is referred to your lab on a given day?

Multiple slides or specimens from a single patient may comprise one accession, or they may represent several accessions that are separately identified and included in a single report, says Slagle. The key to defining accession is the date the tissue or slides were originally processed, and the area of the body the specimen(s) came from, she continues. For example, if a patient had a skin lesion removed that was later reported malignant, with margins not clear, an excision may have been scheduled for a later date. These two sets of slidesone from the original excision and one from the re-excisionwere referred to a pathologist for a consultation. If we received slides dated Oct. 10, 1999, and additional slides from the same patient dated Oct. 12, 1999, we would code for two consults (88321), says Slagle. They are considered two accessions because of the different dates on the slides.

Ken Wolfgang, MT (ASCP), CPC,CPC-H, president and CEO of Kenneth E. Wolfgang, Inc., Health Services Consulting in Portland, OR, a coding consultation company focusing on hospital pathology labs, agrees. Aside from date of sample, different geography on the body is another criterion for determining accession, he says. If tissues taken from two different organ systems in the same patient on the same date are submitted to the lab for a consultation, they are considered two accessions. For example, if tissue from a rectal carcinoma (154.1, malignant neoplasm of rectum) is referred along with tissue from a distinct neoplasm of the cervix (179, malignant neoplasm of uterus, part [...]