Pathology/Lab Coding Alert

Version 10.2 will make sure you don't unbundle 88329 from FNA interpretation

You already know that a fine needle aspiration (FNA) interpretation includes all slides that the pathologist prepares and evaluates, but National Correct Coding Initiative (NCCI) edits, version 10.2, make it official for another non-gyn cytopathology method. The edits added a mutually exclusive edit pair for codes CPT 88173 (Cytopathology, evaluation of fine needle aspirate; interpretation and report) and 88108 (Cytopathology, concentration technique, smears and interpretation [e.g., Saccommano technique]).

NCCI 10.2 took effect July 1. You can access the edits at http://www.cms.hhs.gov/physicians/cciedits/default.asp.

88173 Includes Slides

Pathologists may prepare FNA slides using direct smear, concentrated smear, or thin-layer preparation techniques. They may interpret multiple slides prepared various ways from a single FNA specimen. "Regardless of the number of slides or the preparation method, you should report 88173 once for each aspirate the pathologist diagnoses," says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha.

NCCI Edits have historically enforced this coding by bundling 88173 with the following codes:

88104 -- Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation

88107 -- ... smears and filter preparation with interpretation

88112 -- Cytopathology, selective cellular enhancement technique with interpretation (e.g., liquid-based slide preparation method), except cervical or vaginal.

Now version 10.2 adds the 88173/88108 mutually exclusive edit pair. You can override the edit by using modifier -59 (Distinct procedural service) if the pathologist interprets concentrated cytopathology smears from a source other than the FNA (such as a concentrated bronchial washing) on the same day as the FNA evaluation.

FNA Includes Intraoperative Consult

Pathologists may evaluate FNA specimens intraopera-tively so the surgeon can use the FNA findings to determine the need for a more invasive procedure. "Because the FNA includes the pathologist's interpretation and report, you should not bill an additional code for consultation during surgery," Slagle says.

NCCI 10.2 makes that interpretation official by bundling 88329 (Pathology consultation during surgery) with both 88173 and 88172 (Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen[s]).