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 of the sputum, which we would stain, screen and interpret, declares Stainton. This was reported using code 88160, or 88162 if there were more than five slides or multiple stains. However, now it is far more common for the sputum to be placed in Saccomanno fluid and sent to us. The Saccomanno technique is a method of concentrating the sputum, which allows us to prepare slides that are more definitive for evaluation because they contain many more cells.

Now when we receive the sputum, we complete the concentration technique and prepare and interpret the smears, he continues. This service would be coded 88108. Note that smears and interpretation is bundled with the 88108 code, so a separate 88160 is not reported in this example. Both codes would be reported together only if both services were provided: interpretation of direct sputum smears (88160), and separate interpretation of concentrated sputum smears (88108).

In this example, we would prepare slides also with a special silver stain to identify the causative organism (pneumocystis carinii), explains Stainton. This is an extra service, which is coded 88312 (special stains; group I for microorganisms [e.g., Gridley, acid fast, methenamine silver], each) in addition to the 88108.

Sheppard points out there is also a histochemical stain technique used in the diagnosis of pneumocystosis. If that test is done as well, code 88342 (immunocytochemistry [including tissue immunoperoxidase], each antibody) should be reported in addition to the other services.

Touch Prep Coding

A touch prep often is performed intra-operatively to evaluate the adequacy of a specimen, such as from a core-needle biopsy of lung or liver, or a bone marrow biopsy, says Stainton. The tissue core is touched to a slide, stained and interpreted, and the radiologist advised regarding the need for another core. Coding for this scenario would be 88161 for touch prep, and 88329 for pathology consultation during surgery. When the pathologist then gives the definitive interpretation of the biopsy specimen, it would be coded according to the tissue source using the appropriate surgical pathology code, says Stainton. For example, code 88305 would be used to report the examination of a bone marrow biopsy or transbronchial lung biopsy, and code 88307 would be reported for the liver needle biopsy.

Touch prep also may be used to evaluate the margins of a tumor resection, again in conjunction with an intra-operative consultation, says Stainton. For example, some cases of breast cancer may be treated with a lumpectomy, which is the removal of the tumor and a surrounding margin of non-cancerous tissue. The way touch prep is used by some pathologists in this application, is that all the margins of the excised tissue are touched to microscope slides, explains Stainton. A cytological exam of the touch preps quickly determines if there are any cancer cells on the margins, and the surgeon can be informed if re-excision is needed during the same operative session. In this example, the touch prep would be coded 88161 for each separately identified margin, and the pathology consultation during surgery would be coded 88329.

If special stains are used with touch preps, they can be coded per stain in addition to the other codes, reports Stainton. For example, if a mucin stain is used to assess adenocarcinoma, code 88313 would be reported. If microorganisms are suspected on the touch prep, a special stain can be carried out for that as well (88312).

Improper uses of 88162

As these examples illustrate, code 88162 is for use with certain cytopathology smears only. Sputum, nipple discharge, or imprints from tissue (touch preps) is about all the 88160 family of codes is used for, reiterates Stainton. Because the 88160 family specifically excludes the preceding cell sources of fluids/washings/brushings and vaginal/cervical, these cases should not be coded using 88162, even if more than five slides or multiple stains are involved. This would include Pap smears and sources such as pleural fluid or bronchial washings.

Although many people have asked if 88162 can be used for other cell studies requiring multiple slides or stains, such as fine needle aspiration (FNA) (88170-88173) or bone marrow aspiration (85095-85097), clearly the answer is no. These cell sources are not part of the 88160-88162 codes, says Sheppard. Stainton agrees. Code 88162 represents service only for a very narrowly defined cell source. Using it to report more than five slides and/or multiple stains for any other cytopathology case is a misuse of the code, he says.