Pathology/Lab Coding Alert

Question: The clinician performs a flexible bronchoscopy with transbronchial biopsy from a lung transplant patient with suspected infection, and submits the specimen to pathology for examination. The pathologist examines the biopsy specimen, performing a Geimsa stain for inclusion bodies, and diagnoses cytomegalovirus. Please suggest appropriate coding for the case.

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Answer: Code the lung biopsy pathology exam as 88305 (Level IV - Surgical pathology, gross and microscopic examination… Lung, transbronchial biopsy …).

The Geimsa stain is a special stain for inclusion bodies from viral infections, such as cytomegalovirus (CMV). The proper code for that service is 88312 (Special stain including interpretation and report; Group I for microorganisms [e.g., acid fast, methenamine silver]).

CMV infection is a problematic complication of lung transplant, especially if the donor was CMV seropositive and the recipient is CMV seronegative. Report the CMV diagnosis as T86.812 (Lung transplant infection). You must also report the causative organism using a secondary code, which is B25.0 (Cytomegaloviral pneumonitis).