Microscopic examination of pathology tissue specimens often involves the use of special stains. To appropriately capture reimbursement for these services,
pathology coders need to be familiar with these stains as well as the specialized rules for reporting them.
Some stains are not separately reportable but are considered bundled with the standard tissue and slide preparation involved in the specimen evaluation, says R.M. Stainton Jr., MD, president of Doctors Anatomic Pathology Services, an independent pathology laboratory in Jonesboro, Ark. Other stains are reported in addition to the primary pathology service, as indicated by their CPT designation as add-on codes (represented by a + sign preceding the code). And other special stains are coded in addition to the primary service, although CPT does not designate them as add-on codes.
The most generally useful and commonly applied stain for microscopic tissue examination is hematoxylin and eosin (H&E), Stainton says. Any of the surgical pathology services that describe microscopic tissue examination will incorporate the H&E stain. This includes listed and unlisted tissue specimens from adrenal gland to vein, reported with 88302-88309 (levels II to VI - surgical pathology, gross and microscopic examination).
Depending on the tissue and the disease process being investigated, the pathologist may use a wide variety of special stains to further elucidate the diagnosis, Stainton says. These tissue stains fall into four main codes:
1. Code +CPT 88312 (special stains [list separately in addition to code for surgical pathology examination]; group I for microorganisms [e.g., Gridley, acid fast, methenamine silver], each);
2. Code +88313 (... group II, all other, [e.g., iron trichrome], except immunocytochemistry and immunoperoxidase stains, each);
3. Code 88314 (... histochemical staining with frozen section[s]); and
4. Code 88342 (immunocytochemistry [including tissue immunoperoxidase], each antibody).
To help coders recognize and assign the correct code for stains they may encounter in narrative documentation of surgical pathology examinations, Stainton describes some of the most commonly used stains:
1. Stains Under 88312
Acid Fast Stain: Almost any time a pathologist observes granulomas in a tissue biopsy, an acid fast stain is ordered. This stain is crucial for the identification of acid-fast bacilli involved in diseases such as tuberculosis (e.g., 010.0x, primary tuberculous infection). For example, if a pathologist examines a transbronchial biopsy of the lung (88305) and notes granulomas, he or she would most likely order an acid fast stain, which could lead to the treatment of this curable disease.
Methenamine Silver, Periodic Acid Shift (PAS), Gridley Stain: These and similar [...]
