Pathology/Lab Coding Alert

Code the scenarios, then compare your response to our experts-

 Think you understand when and how to report intraoperative frozen sections and touch preps together--and when not to? Look at the following two scenarios and try coding the cases. Then you can read our experts- answers and explanations to make sure you get the coding right--every time.

Scenario 1--The Problem

The pathologist goes to surgery to render an intraoperative consult with a breast case that's under way. The surgeon shows the pathologist the partial mastectomy (lumpectomy) specimen that he removed from the patient's right breast.

The surgeon asks the pathologist to perform a frozen section on the mass to confirm that it's cancerous. The surgeon also points out the long and short sutures that mark the medial and lateral margins of the specimen. He asks the pathologist to evaluate those margins in particular due to concern that they may show residual tumor.

The pathologist performs a rapid microscopic examination of the lumpectomy specimen as a whole using frozen section technique (one block) and jots down her immediate diagnosis, which is -infiltrating ductal carcinoma.- She then microscopically examines each of the two resection margins the surgeon has marked.

The pathologist decides to conduct the exam by touch preparation technique to ensure a broad surface area of each margin for evaluation. After individually examining each margin separately under the microscope, she jots down her findings: -medial margin: no tumor present; lateral margin: no tumor present.-

The pathologist walks back into the operating room and verbally reports the outcome of her examination to the surgeon, who then proceeds to close the surgical wound.

Scenario 1--The Solution

The lumpectomy in this case represents the specimen, but the pathologist examines three different sites from the specimen that you should code individually, says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc., a pathology business practices publishing company in Simpsonville, Ky. The three sites/services are the frozen block from the tumor plus the separately marked medial and lateral resection margins. Each site is medically significant to the patient's care and treatment. Neither touch preparation exam in any way duplicates the frozen section exam.

You should report the case as 88331 (Pathology consultation during surgery; first tissue block, with frozen section[s], single specimen) for the frozen section, plus 88334-59 x 2 (... cytologic examination [e.g., touch prep, squash prep], each additional site; distinct procedural service) for the two distinct margin touch preps, Padget says.

Responding to this scenario, Niles R. Rosen, MD, medical director of National Correct Coding Initiative, says that you may report both 88331 and 88334 -if the margins of resection are distinct sites separate from the site of the frozen section of the tumor.- Rosen cautions, -However, pathologists should not improperly bypass this NCCI edit by performing touch preparations on margins of resection that are clearly free of tumor unless specifically requested by the surgeon.-

Scenario 2--The Problem

The pathologist goes to surgery for a Medicare patient and examines a breast biopsy using touch preparation. He then prepares a block and evaluates frozen sections of the biopsy. The pathologist uses the touch prep to provide cytologic detail that he loses by artifacts and distortion introduced by the freezing process.

He submits an intraoperative diagnosis of adenocarcinoma based on the results of the touch prep and the frozen sections.

Scenario 2--The Solution

You should not report both the frozen section and the touch prep for the Medicare patient in this case because the pathologist does not perform the services on different sites--the only scenario that NCCI clarification has approved for overriding the 88331-88334 edit pair.

-You should code the pathologist's work in this case as 88331,- Padget says. The case does not satisfy Medicare's criteria to override the NCCI edit pair and report both 88331 and 88334 using modifier 59.