Pathology/Lab Coding Alert

Reader Question:

Apply Special Stain Codes With Primary Service

Published on Sat Oct 30, 2004

Question: When the pathologist performs special stains on a tissue specimen, such as an AFB stain for observed prostate granulomas, we report the special stain code in addition to the surgical pathology code. Can we also report these special stain add-on codes for other, non-tissue specimens?

California Subscriber

Answer: Yes, you can report special stain codes from the surgical pathology section for non-tissue specimens. CPT 2004 clarified this issue by instructing coders to list the special stain codes in addition to the code for the "primary service," rather than for the "surgical pathology examination."

The special stain add-on codes are:

+88312 - Special stains (list separately in addition to code for primary service); Group I for microorganisms (e.g., Gridley, acid fast, methenamine silver), each

+88313 - ... Group II, all other (e.g., iron, trichrome), except immunocytochemistry and immunoperoxidase stains, each

+88314 - ... histochemical staining with frozen section(s). The lab might perform special stains on a number of non-tissue sources. For example, the lab may perform a trichrome on a direct fecal smear for ova and parasites, in which case you would report 87177 (Ova and parasites, direct smears, concentration and identification) for the smear examination, and 88313 for the trichrome stain.

Or the lab may perform an acid-fast bacillus (AFB) stain on a lymph node fine-needle aspiration (FNA) sample submitted from a patient with suspected granulomatous disease. In this case, report the pathologist's examination of the FNA as 88173 (Cytopathology, evaluation of fine needle aspirate; interpretation and report). For the additional AFB stain service, also report 88312, because this was a Group I stain for microorganisms.

In another example, a pathologist may perform a bone marrow aspiration, evaluate the smears, and perform and interpret an iron stain for the diagnosis of iron-deficiency anemia. Report the bone marrow aspiration as 38220 (Bone marrow; aspiration only) and the evaluation as 85097 (Bone marrow, smear interpretation). And report 88313 for performing and interpreting the iron stain. - Reader Questions were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctor's Anatomic Pathology, an independent pathology laboratory in Jonesboro, Ark.

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