Pathology/Lab Coding Alert

Question: We keep getting conflicting information regarding how many cell blocks are chargeable per non-gynecological cytology specimen. If I examine two or more cell blocks from one cytology sample, can I charge 88305 multiple times, or only once?

Florida Subscriber

Answer: The unit of service for surgical pathology procedures (88300-88309) is the specimen, defined as "tissue or tissues submitted for individual and separate attention, requiring individual examination and pathologic diagnosis." Because a cell block is derived from another specimen (e.g., pleural fluid), whether multiple cell blocks represent what the definition calls "tissues" from one specimen or whether each cell block (a listed specimen under 88305) represents an individual "tissue" is not clear for purposes of the definition.

According to Dennis Padget, CPA, FHFMA, president of Padget & Associates, a pathology compliance-consulting firm in Simpsonville, Ky., a response he received from the AMA's CPT Information Services unit settles the question. The AMA states that 88305 (Level IV Surgical pathology, gross and microscopic examination, cell block, any source) is billable once per cell block.

For example, if a single pleural fluid sample yields three cell blocks for examination and report, then 88305 is billable three times, once for each cell block, in addition to the code for the smear (e.g., 88104, Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation). This link between "cell block" and "tissue" extends to all primary sample sources (i.e., fine needle aspirates, other non-gynecological cytology fluids, and bone marrow aspirates). The pathology report must clearly demonstrate the number of cell blocks that were prepared, microscopically examined and considered in the diagnosis to support the multiple 88305 charge units. As always, each individual service billed to government and private insurers must be medically necessary.