Pathology/Lab Coding Alert

Question: Given a renal biopsy for suspected cyclosporine toxicity following cardiac transplant, we performed two H&E stains, two PASs, two Jones' methenamine silver stains, and two trichromes. We also froze a core from the biopsy in methylbutane to process for direct immunofluorescence studies: IgG, IgA, Igm, Clq and C3. How should we code this? Can we use 88314 to report preparing frozen sections for the immunofluorescence studies? Missouri Subscriber Answer: Report 88305 (Level IV - Surgical pathology, gross and microscopic examination, kidney, biopsy) for the renal biopsy, including the hematoxylon and eosin (H&E) stains. Report the periodic acid schiff (PAS), Jones' methenamine silver and trichrome stains as 3 x +88313 (Special stains [list separately in addition to code for surgical pathology examination]; Group II, all other [e.g., iron, trichrome] except immunocytochemistry and immunoperoxidase stains, each). You should report each immunofluorescent antibody study as 88346 (Immunofluorescent study, each antibody; direct method), meaning that you would report 5 x 88346 for this example. You should not report +88314 (...; histochemical staining with frozen section[s]) for preparing frozen sections for the immunofluorescent studies. Code 88346 includes tissue/slide preparation and examination. Code 88314 describes the preparation and examination of a different (histochemical) staining technique, such as muscle biopsy ATPase or NADH stains. The code describes not just frozen section preparation but the histochemical staining and examination as well.