Pathology/Lab Coding Alert

Question: Our pathologist extracted a needle core breast biopsy -- not an FNA. The cytotech did a touch  rep to confirm the presence of adequate lesion cells, and the pathologist later diagnosed the biopsy specimen. Can we report the cytotech's "adequacy check" as 88172 or 88333 or 88161?

New York Subscriber

Answer: You should consider the touch prep that the cytotechnologist performed to ensure an adequate specimen an unbillable service. Here's why you should not report each of the codes you suggested:

• 88172 -- Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen(s)

This code is only for a fine needle aspiration (FNA) adequacy check, but the specimen you describe is not a fine needle aspirate.

• 88333 -- Pathology consultation during surgery; cytologic examination (e.g., touch prep, squash prep), initial site

You should not use this code for the cytotech's touch prep. The service doesn't meet the consultation requirements -- you don't have a request for an intraoperative consult or a report showing that the pathologist rendered a medical opinion.

• 88161 -- Cytopathology, smears, any other source; preparation, screening and interpretation.

The touch prep does not involve physician interpretation, so you should not bill 88161.

Watch edits: Medicare bundles 88161 with the surgical pathology code that you should report for the pathologist's biopsy exam (88305, Level IV -- Surgical pathology, gross and microscopic examination, breast, biopsy, not requiring microscopic evaluation of surgical margins). The touch prep is for the biopsy specimen, so you should not override the Correct Coding Initiative edit with modifier 59 (Distinct procedural service), even for a technical component charge.