Pathology/Lab Coding Alert

Question: A distant hospital sends us slides via telemetry. Our pathologist examines the slides and reports his findings back to the hospital. How should we report this service, and are there special telehealth rules that we must follow?

Connecticut Subscriber Answer: You should code the telepathology service just as you would code it if the pathologist had received physical slides. The service may be either a surgical athology examination or a consultation, depending on the specifics of the case.

If a hospital prepares the slides, such as from a stomach biopsy, and asks your pathologist to examine and diagnose the slides, you should report 88305 (Level IV - Surgical pathology, gross and microscopic examination, stomach, biopsy). You should append modifier -26 (Professional component) to the code since your pathologist only performs the physician professional portion of the service.

If the hospital requests a pathology consultation on the telemetry slides as a "second opinion," however, you should report 88321 (Consultation and report on referred slides prepared elsewhere). You should never report slides examined via telemetry using code 88323 (Consultation and report on referred material requiring preparation of slides), because your lab does not prepare the slides from tissue. If the consultation is more thorough, involving the pathologist's review of the complete patient record, you should report 88325 (Consultation, comprehensive, with review of records and specimens, with report on referred material).

Sometimes pathologists perform a consultation on frozen section slides via telemetry during patient surgery. In these cases, use 88331 (Pathology consultation during surgery; first tissue block, with frozen section[s], single specimen) and 88332 (... each additional tissue block with frozen section[s]). Because your pathologist does not prepare the frozen sections, you should only report the professional component of these codes. That means you should report the codes with modifier -26.

Medicare carriers have discretion to cover and pay for telepathology under Section 2020A of the Medicare Carriers Manual, which describes services not requiring a face-to-face patient encounter that are delivered via a telecommunications system. The coverage includes services such as the interpretation of an x-ray, electroencephalogram, electrocardiogram or tissue samples. The transmission of a tissue sample image via telecommunications system does not change the method for payment. That means you should not have to comply with any special telehealth rules, but check with your local carrier for any specific instructions. 

- Reader Questions were prepared with the assistance of Laurie Castillo, MA, CPC, CPC-H, CCS-P, owner of Castillo Consulting in Manassas, Va.