Pathology/Lab Coding Alert

Question: How should we report a pleural fluid evaluation that requires two direct smears and two smears from concentrated fluid using cytospin technique?

California Subscriber

Answer: Report the two direct smears of pleural fluid as 88104 (Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation). Additionally, report the two smears from the cytospin as 88108 (Cytopathology, concentration technique, smears and interpretation [e.g., Saccomanno technique]).

Confusion continues about using these codes together despite clarifications made in CPT Assistant (January 1998). Before that time, 88108 was indented under 88104, meaning that they were a part of the same code family. However, the concentration technique given as an example in 88108 is commonly used with sputum specimens, which are reported with the family of codes beginning with 88160 (Cytopathology, smears, any other source; screening and interpretation).

To allow wider use of 88108 to describe concentration techniques carried out for any type of cytopathology specimen, the code was modified and unindented in the CPT manual. Removing 88108 from the 88104 family also clarified the fact that the concentration techniques represent a separate service that is reportable in addition to any initial smear evaluation.