Pathology/Lab Coding Alert

Question: Our lab receives a non-gyn specimen and processes it with the following steps: 1) Millipore filter, 2) centrifuge for 10 minutes, 3) vacuum wash cells with Hanks solution on cellulose filter, 4) direct smear remaining cells onto slide. Sometimes we perform the same steps except for centrifugation (step 2). Does new CPT code 88112 describe either of these processes, and if not, what are the correct codes for these procedures?

Virginia Subscriber

Answer: New in CPT 2004, code 88112 (Cytopathology, selective cellular enhancement technique with interpretation [e.g., liquid-based slide preparation method], except cervical or vaginal) describes a complex procedure that includes not just concentration but also enrichment of cells for evaluation.

In its "Rationale" for code 88112 published in CPT Changes 2004 An Insider's View, the AMA states:

"Code 88112 was added to describe new cellular enhancement technologies that allow both concentration and enrichment of cytology specimens. Because these cellular enhancement techniques have the ability to concentrate diagnostic material and remove background contaminating debris, they now can be used on complicated specimens that could not be evaluated with typical concentration techniques."

Two examples of procedures that warrant the use of 88112 are commercial liquid-based cytology such as SurePath or ThinPrep, when the technique involves selective enrichment of the desired cells.

You should not report 88112 for the second example you describe, which involves only filtration. You should report that process as 88106 (Cytopathology, fluids, washings or brushings, except cervical or vaginal; filter method only with interpretation).

Before CPT added 88112, the best code to describe your first example would have been 88108 (Cytopathology, concentration technique, smears and interpretation [e.g., Saccomanno technique]). Code 88108 offered the best description of cytospin processing of non-gyn specimens for smear examination. Some experts now believe that a liquid-based specimen processed by filtration and centrifugation to concentrate the cells for examination - such as the process you describe in your first example - warrants using code 88112. Others hold that this process does not fit the definition of "selective cellular enhancement," so 88108 still most closely describes your first example.