Pathology/Lab Coding Alert

Warning: Beware of other cytology bundles

Finally, you can report frozen sections and touch preps together as part of a pathology consultation during surgery--but first you’ll have to learn how to maneuver edit pairs in the latest National Correct Coding Initiative (NCCI) edits (version 12.0).

You won’t get paid for both services if you choose the bundled frozen section and touch prep codes. 

NCCI 12.0 took effect Jan. 1. You can access the edits online at www.cms.hhs.gov/physicians/cciedits/default.asp.

Use 88334 With Frozen Sections

NCCI 12.0 confirms it: You can report both touch preps and frozen sections together during the same surgical pathology consultation. Using both touch preps and frozen sections during a surgical consultation is not unusual, says Stephen Yurco III, MD, partner and pathologist at Clinical Pathology Associates in Austin, Texas. Yet past NCCI Edits disallowed payment for both services.

The addition of CPT codes 88333 (Pathology consultation during surgery; cytologic examination [e.g., touch prep, squash prep], initial site) and 88334 (… cytologic examination [e.g., touch prep, squash prep], each additional site) solves the problem.

Here’s how: According to a new CPT text note following 88334, “For intraoperative consultation on a specimen requiring both frozen section and cytologic evaluation, use 88331 and 88334.” NCCI 12.0 does not bundle 88334 with frozen section codes 88331 (Pathology consultation during surgery; first tissue block, with frozen section[s], single specimen) or 88332 (… each additional tissue block with frozen section[s]), confirming that you can report the services together.

Hidden trap: NCCI 12.0, however, does bundle 88333 with both 88331 and 88332. That means you will not get paid for touch preps with frozen sections if you report the touch prep with 88333--you must use 88334.

Don’t Double-Dip Cytology Services

Other than frozen sections, NCCI 12.0 places lots of restrictions on 88333 and 88334. Because intraoperative touch preps are a cytology service, NCCI bundles 88333 and 88334 with the following cytology procedures that provide similar diagnostic information:

• 88160--Cytopathology, smears, any other source; screening and interpretation
• 88161--... preparation, screening and interpretation
• 88162--… extended study involving over 5 slides and/or multiple stains
• 88172--Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen(s)
• 88173--… interpretation and report.

Don’t overlook: Just to make sure you’re not confused about the new codes’ relationship to fine needle aspiration (FNA) cytology evaluation, CPT added this note under 88334: “Do not report 88333 and 88334 for intraprocedural cytologic evaluation of fine needle aspirate, see 88172.” The edit pairs confirm this distinction and require that you “choose only one code,” as the NCCI policy manual instructs.

What to do: To choose the right touch-prep code, you should remember that 88333 and 88334 are only for an intraoperative service. “You should continue to use cytology codes for smears that are not part of a surgical consultation,” says Ernest J. Conforti, MSHS, SCT (ASCP) MT, assistant director of anatomic pathology operations at North Shore-Long Island Jewish Health System, headquartered in Great Neck, N.Y.

Watch for parent code: 88329 (Pathology consultation during surgery) is the parent code for 88333 and 88334, so NCCI bundles them, and you should not report them together. The touch-prep codes include the consultation service.