Pathology/Lab Coding Alert

Question: If our pathologist examines slides from an FNA that require cytospin concentration, then consults in the operating room with the surgeon on the FNA findings, can we code for the FNA, concentration and consultation?


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Answer: When a pathologist evaluates a fine needle aspiration (FNA), report the service as 88173 (Cytopathology, evaluation of fine needle aspirate; interpretation and report). The global charge for this code includes preparing, interpreting and reporting.

Do this: That means an FNA evaluation includes all the slides, regardless of how the cytotechnologist or pathologist prepares them. They may prepare FNA slides using direct smear, concentrated smear or thin-layer preparation techniques. They may interpret multiple slides prepared various ways from a single FNA specimen. Regardless of the number of slides or the preparation method, you should report 88173 once for each aspirate the pathologist diagnoses.

National Correct Coding Initiative (NCCI) edits enforce this coding by bundling 88173 with the following codes:

- 88104 -- Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation

- 88107 -- ... smears and filter preparation with interpretation

- 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.

Experts agree: The February 2004 CAP Today states, -Code 88173 encompasses the fine-needle aspirate cytologic evaluation and interpretation with report, irrespective of the method and type of preparation and the number of slides.-

Include this: Pathologists often evaluate FNA specimens intraoperatively so the surgeon can use the findings to determine the need for a more invasive procedure. Because the FNA includes the pathologist's interpretation and report, you should not bill an additional code for consultation during surgery.

That's why NCCI bundles 88329 (Pathology consultation during surgery) with 88173.

Separate service: When the pathologist performs an immediate evaluation of an FNA specimen to determine adequacy, you should report 88172 (Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen[s]). You should use 88172 in addition to the 88173 interpretation when the pathologist performs both services.

Reader Questions and You Be the Coder were prepared with the assistance of R. M. Stainton Jr., MD, president of Doctors- Anatomic Pathology Services in Jonesboro, Ark.