Pathology/Lab Coding Alert

Question: When our cytology lab processes a cyst aspirate specimen, how do we know when to use non-gyn cytopathology code(s) versus FNA code(s)? Is the cyst location the key (such as breast versus cervical)?

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Answer: What distinguishes your cytopathology code selection for cysts or other cellular material is not body site (breast or other), but the specimen itself. The specimen type is based on the surgical procedure used to acquire the cells.

Non-gyn cytopathology: The physician may acquire the specimen by performing a puncture aspiration using a needle (such as 19000, Puncture aspiration of cyst of breast; or 10160, Puncture aspiration of abscess, hematoma, bulla, or cyst; or 32421, Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent). For specimens from these and similar surgical procedures used to acquire non-gyn cytology specimens, you should code your cytopathology exam using code(s) from the following list:

• 88104-88107 -- Cytopathology, fluids, washings or brushings, except cervical or vaginal ...)
• 88108 -- Cytopathology, concentration technique, smears and interpretation (e.g., Saccomanno technique)
• 88112 -- Cytopathology, selective cellular enhancement technique with interpretation (e.g., liquid based slide preparation method), except cervical or vaginal

Fine needle aspiration (FNA): If the physician who acquires the specimen uses a fine needle to aspirate cells (10021 or 10022, Fine needle aspiration ...), then you should report the cytopathology exam of the specimen using appropriate code(s) from the following list:

• 88172 -- Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, first evaluation episode, each site
• +88177 -- ... immediate cytohistologic study to determine adequacy for diagnosis, each separate additional evaluation episode, same site (List separately in addition to code for primary procedure)
• 88173 -- ... interpretation and report.

Don't miss: The cytology specimen from an FNA and a cyst/puncture aspiration may look the same, and the pathologist may process it the same (as direct or concentrated smears), so distinguishing the two services may be difficult. You'll need to use the surgical code to guide your selection of specimen type and cytology code.