Pathology/Lab Coding Alert

Question: For fine needle aspirate specimens, if we receive prepared slides and a vial with the needle rinse from which we prepare smears, can we report both an FNA evaluation as 88173 and a separate code for the washing, such as 88104? Under what circumstances should we report 88172 for an FNA?

Georgia Subscriber

Answer: For evaluation of a fine needle aspirate (FNA), you should report only 88173 (Cytopathology, evaluation of fine needle aspirate; interpretation and report). The FNA is a single specimen, regardless of the number of smears you evaluate or how you prepare them. You should not report 88104 (Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation) in addition to 88173 for the FNA, even if you prepare additional smears from the needle washing.

Use code 88172 (Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen[s]) when the pathologist examines the FNA specimen intraoperatively to ensure that there is sufficient material for diagnosis.

Whether the pathologist or another physician performs the FNA (reported as 10021, Fine needle aspiration; without imaging guidance, or 10022, with imaging guidance), the pathologist evaluates for adequacy. If the pathologist performs both the FNA extraction and the check for adequacy because of the potential for conflict of interest, reporting more than one unit of 88172 may not be prudent regardless of the number of "passes" needed to secure an adequate specimen. On the other hand, if another physician performs the aspiration and requests two adequacy determinations (separate passes) at two different times, the pathologist would report two units of 88172. Report 88173 in addition to 88172 when the pathologist completes the final interpretation and report for the FNA.