Pathology/Lab Coding Alert

Question: Our pathologist received a bronchial lavage specimen from a Medicare patient and examined direct smears, liquid-based cellular-enhancement smears, and processed and examined slides from a cell block. The pathologist examined sliver stains on the lavage liquid-based slides, noting positive for fungus, as well as silver stains on slides from the cell block noting negative for Pneumocystis. How should we code the case?

Tennessee Subscriber

Answer: You should report 88112 (Cytopathology, selective cellular enhancement technique with interpretation [e.g., liquid based slide preparation method], except cervical or vaginal), 88305 (Level IV - Surgical pathology, gross and microscopic examination, Cell block, any source), and 88312 x 2 (Special stain including interpretation and report; Group I for microorganisms (e.g., acid fast, methenamine silver).

Cytopathology: Although your pathologist examines the bronchial lavage using both direct smears (88104, Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation) and liquid-based smears, Medicare allows you to report only "one code from the CPT code range 88104-88112," according to the Correct Coding Initiative CCI Policy Manual. Other payers may allow you to report 88104 and 88112 together, however.

Cell block: Pathologists often process and examine a cell block from washing specimens, as in your case. You can capture that service as 88305. Regardless of the number of cell blocks, report only one unit of 88305 for one specimen.

Special stains: The pathologist examined silver stains to aid in diagnosing possible infective organisms, noting positive for fungus and negative for Pneumocystis. Because he evaluated silver stains on two separate preparations -- the 88112 slides and the 88305 slides, you can bill two units of the 88312. CPT® instructs, "Report one unit of 88312 for each special stain, on each surgical pathology block, cytologic specimen, or hematologic smear."