Pathology/Lab Coding Alert

Steer clear of 89060 with 88302-88309 -- you could be sending up a red flag

Now that you can use the crystal-identification microscopy code for tissue -- not just fluids -- make sure you don't use the code to unbundle microscopic examination of surgical pathology tissue specimens.

Surgical pathology codes 88302-88309 (Surgical pathology, gross and microscopic examination) include the microscopy service.

Don't Let Code Change Confuse You

CPT 2007 revised 89060 (Crystal identification by light microscopy with or without polarizing lens analysis, tissue or any body fluid [except urine]) to include tissue specimens. To clarify that you should not use the code on surgical pathology specimens processed as paraffin blocks, CPT added the note -Do not report 89060 for crystal identification on paraffin-embedded tissue.-

On the other hand, some labs examine thin tissue sections using polarized light microscopy to analyze tissue mineral deposits. CPT revised 89060 to allow labs to use the code for this specialized service that is distinct from a surgical pathology examination.

For instance: -Labs often perform the 89060 service on specimens such as fluid from the knee to evaluate for conditions such as gout,- says Elizabeth Sheppard, HT (ASCP), marketing manager for Ventana Medical Systems in Tucson, Ariz. Aside from synovial fluid, which the old 89060 definition includes, labs might also use polarized light microscopy to identify monosodium urate crystals in tissue prepared from extremities, which the revised 89060 definition allows as well.

NCCI Weighs In

National Correct Coding Initiative version 13.0 enforces the restriction on using the revised code for surgical pathology specimens by bundling 89060 with 88302-88309.

Reminder: The code definition for 88302-88309 includes the microscopic exam -- additionally reporting another microscopy code for the service amounts to unbundling.

Exception: If the pathologist performs two unrelated services, such as a skin biopsy (88305, Level IV -- surgical pathology, gross and microscopic examination, skin, other than cyst/tag/debridement/plastic repair)  and a synovial fluid light microscopy exam for gout (89060), you can report both codes. Because NCCI lists the code pairs with a modifier indicator of -1,- you can override the edit pair using modifier 59 (Distinct procedural service) to indicate that you are not unbundling a single procedure.