Pathology/Lab Coding Alert

Seemingly an oasis for lab personnel and pathologists toiling through a tray of slides on a single case, code 88162 (cytopathology, smears, any other source; extended study involving over 5 slides and/or multiple stains), in fact, represents a very specific service, rendered only for a particular group of cytopathology samples, according to R.M. Stainton, MD, president of Doctors Anatomic Pathology Services, an independent pathology laboratory in Jonesboro, Ark.

Code 88162 is not an add-on code, and it is not to be used every time a cytopathology evaluation involves more than five slides or multiple stains, advises Stainton.

"This code, 88162, is part of the 88160 (cytopathology, smears, any other source; screening and interpretation) family of codes, states Elizabeth Sheppard, HT (ASCP), manager of anatomic pathology at Wake Forest University Baptist Medical Center in Winston Salem, N.C. To understand what is meant by any other source, you have to look back at the preceding cytopathology codes. These earlier codes deal with samples from fluids, washings or brushings, (88104-88107) or cervical or vaginal sources (codes 88141-88155). Any other source in the 88160 family means cytopathology samples that are non-gynecological, or non-fluids/washings/brushings in origin, says Sheppard.

A good example would be smears from sputum or nipple secretions, declares Sheppard. If the sample is received as slide(s), which we stain, the screening and evaluation is coded as 88160, or 88162 if more than five slides are submitted. If the sample requires preparation of slide(s) prior to screening and evaluation, it is coded 88161 (cytopathology, smears, any other source; preparation, screening and interpretation), or 88162 for an extended study.

But the truth is, we really dont use 88160 or 88162 very much, reports Stainton. Sputum and nipple secretions are among the few cytopathology samples that fall into this category of non-gynecological, and non-fluids, washings or brushings. And since sputum commonly is concentrated before evaluation, often it is reported using a different code (88108, cytopathology, concentration technique, smears and interpretation [e.g., Saccomanno technique]).

We are using code 88161 more and more, though, because it is used also to report a procedure known as touch or crush preps, says Stainton Touch preps are carried out by touching a slide to the surface of the tissue to be evaluated. Cells from the tissue adhere to the slide, then can be stained and interpreted. This technique provides a more rapid method for specimen preparation than standard frozen sections, and often is used as an adjunct diagnostic method.

Clinical Example: Pneumocystosis

A patient with a compromised immune system (e.g., AIDS) presents with a dry cough, fever and shortness of breath. The physician may suspect pneumocystosis and order an induced sputum sample for evaluation. It used to be that we would receive multiple slides [...]