Pathology/Lab Coding Alert

Question: Our pathologists occasionally receive slides for interpretation that have been prepared by another pathologist at a distant location. Either the off-site pathologist or the patient's physician requests a second opinion on these slides from our pathologists. The number of slides varies from a few to as many as 20 or more. What is the proper code for this service, and should we bill per slide?

Minnesota Subscriber

Answer: The correct code for your pathologist's consultation on slides submitted from a different site is 88321 (Consultation and report on referred slides prepared elsewhere). If the referring pathologist also sent material requiring that your pathologist prepare slides, you should report 88323 (Consultation and report on referred material requiring preparation of slides).

Using these codes can be confusing because the unit of service is not the specimen, as it is for other surgical pathology procedures. Rather, the unit of service is the material from a single surgical case submitted for review and report. For example, the pathologist may receive a consultation request for slides from a radical prostatectomy that included multiple specimens such as prostate and two regional lymph node groups. You should report one unit of 88321 for this service because the referred slides were from one surgical case.

If the pathologist receives consultation requests for slides from the same patient representing two separate surgical cases, such as a mastectomy from one date and lymph node fine needle aspiration slides taken at a later date, you should report two units of 88321. You should never report 88321 per slide. If the consultation involves a complete review of the patient's records and pathology specimens, not just a case review with pathology report, you should report 88325 (Consultation, comprehensive, with review of records and specimens, with report on referred material).