Pathology/Lab Coding Alert

Question: Our pathology group often provides a pathologist for immediate cytohistologic evaluation to determine adequacy of radiologically guided aspirates. We do not actually do the aspiration. After the immediate evaluation, we process the material for final review and subsequently provide a final interpretation and report. What is the appropriate coding for this? At least one carrier in our area states the final evaluation (88173) is included in the immediate evaluation (88172) and only one of these codes can be used. Is this your interpretation of the codes? Should an 88329 be used for an intraoperative consultation when performing an immediate evaluation of a needle aspirate specimen?

Kenneth Algino, M.D.
Boise, Idaho

Answer: Note: The terminology with or without preparation of smears has been deleted in the 2001 CPT manual for codes 88170, 88171, 88172 and 88173. However, the wording change does not alter the answer to this question.

In your description, you have provided two separate services. The first is the immediate evaluation of aspirate for adequacy. This is reported using 88172 (cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen[s]). The second service is the interpretation and report on the fine needle aspiration (FNA), which is reported as 88173 ( ... ; interpretation and report). CPT Assistant December 1998 clarifies this point by stating that following the reporting of 88172 regarding specimen adequacy, For final interpretation and report of the fine needle aspirate evaluation, you should additionally report code 88173.

Code 88329 (pathology consultation during surgery) should not be reported in addition to 88172 and 88173 for the services described. The immediate evaluation during the FNA to determine adequacy is fully covered by the 88172 code.

If you do not do the aspiration, that does not change the coding outlined above because different codes are used to describe the removal of the aspirate. These are codes 88170 (fine needle aspiration; superficial tissue [e.g., thyroid, breast, prostate]) and 88171 ( ... ; deep tissue under radiologic guidance).


Answers to Reader Questions and You Be the Coder provided by Laurie Castillo, MA, CPC, CPC-H, CCS-P, a member of the National Advisory Board of the American Academy of Professional Coders and president of its Northern Virginia Chapter.