Pathology/Lab Coding Alert

Question: Our pathologist cuts a lymph node, then touches slides to each half, and stains and interprets the slides (touch prep). The pathologist then takes a blade and scrapes each cut surface to release cells which were too cohesive to come off on the touch prep, again touching each scraped surface to slides for stain and interpretation (scrape prep). Can we bill for both the touch preps and the scrape preps?

New York Subscriber

Answer: You should not individually bill both touch preps and "scrape preps" in this case, because they're from the same site.

You should code this case as 88161 (Cytopathology, smears, any other source; preparation, screening and interpretation). Notice that the definition involves "smears" (multiple) from a single source (specimen).

Opportunity: If the case involves more than five slides or multiple stains, you can bill 88162 (Cytopathology, smears, any other source; extended study involving over 5 slides and/or multiple stains) instead of 88161.

Caution: If your pathologist performs the touch preps as part of a lymph node biopsy, you can't separately bill both 88305 (88305, Level IV - Surgical pathology, gross and microscopic examination, Lymph node, biopsy) and 88161, because Correct Coding Initiative (CCI) bundles these codes for the same specimen. In other words, touch preps of a biopsy specimen are considered part of the biopsy evaluation service.

Watch for "intraoperative": Your example doesn't give any indication that the case is an intraoperative consult. But if the pathologist performs the touch preps as part of a consultation during surgery, you should bill the service using codes 88333-88334 (Pathology consultation during surgery; cytologic examination [e.g., touch prep, squash prep] ...) instead of 88161-88162.