Pathology/Lab Coding Alert

Make sure you distinguish aspiration specimens -- find out how. If you don't know needles, margins, and lymph nodes, you could be leaving money on the table for your pathologist's breast cases. Our experts help you break down breast coding into four easy steps. Follow these guidelines to capture all your breast pathology pay. 1. Define Needle Specimen Surgeons sometimes take needle extractions from breast lesions. To get the code right, you-ll need to understand the different specimens and procedures your pathologist might encounter for these needle samples. Cyst puncture aspiration: -If the surgeon uses a needle to withdraw fluid from a breast cyst, your pathologist will examine a cytology specimen,- explains Melanie Witt, RN, CPC-OBGYN, MA, a coding expert based out of Guadalupita, N.M. That means you-ll choose a code from the following list: - 88104 -- Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation
- 88106 -- - simple filter method with interpretation
- 88107 -- - smears and simple filter preparation with interpretation
- 88108 -- Cytopathology, concentration technique, smears and interpretation (e.g., Saccomanno technique)
- 88112 -- Cytopathology, selective cellular enhancement technique with interpretation (e.g., liquid based slide preparation method), except cervical or vaginal. Your pathologist will be looking at cells from a fluid specimen, and you should choose one of the above codes based on the lab method used to prepare the slides. FNA: If the surgeon uses a -fine- needle to -aspirate- cells from a solid breast tumor, the specimen is a -fine needle aspiration- (FNA). Although an FNA specimen is cellular, and thus a cytology specimen, CPT provides different codes for FNA than for cytology specimens described by 88104-88112. You should report the pathologist's diagnosis of the FNA specimen as 88173 (Cytopathology, evaluation of fine needle aspirate; interpretation and report). Although the lab might prepare the FNA slides by various methods described by 88104-88112, such as direct smear or concentrated smear, you should not report one of these codes in addition to 88173 for the FNA specimen. -Code 88173 includes interpretation of all slides examined from the aspirate regardless of slide preparation method,- Witt cautions. Pitfall: The cytology specimen from an FNA and a cyst aspiration may look the same, and the pathologist may process it the same (as direct or concentrated smears), so distinguishing the two services may be difficult. Tip: -We use the surgical code to guide our selection of the specimen type,- says R.M. Stainton Jr., MD, president of Doctors- Anatomic Pathology Services in Jonesboro, Ark. If the surgeon performs 19000 (Puncture aspiration of cyst of breast), select the proper cytology code (88104-88112). If the surgeon performs 10021 (Fine needle aspiration; without imaging guidance) or 10022 (- with imaging guidance), [...]