Pathology/Lab Coding Alert

Question: Our pathologist received 2cc colorless, slightly hazy fluid from bronchial lavage, concentrated the specimen using cytospin, and examined slides prepared from the concentrated sample. Should we report this as 88104 or 88112, since those are the two cytology codes that describe "fluids" or "liquid" specimens?

Tennessee Subscriber

Answer: Neither 88104 (Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation) nor 88112 (Cytopathology, selective cellular enhancement technique with interpretation [e.g., liquid based slide preparation method], except cervical or vaginal) best describes the service your pathologist performs.

Non-gyn cytopathology (cytology) specimens are usually fluids (washings, or aspirations of fluids such as cyst or cerebrospinal fluid) or brushings or sputum (88104-88112). How you prepare the specimen is the key to code choice (88104-88112), not whether the specimen is a fluid or a brushing to begin with.

If the pathologist processes the specimen as a direct smear (simply smearing some of the specimen on a slide), you choose 88104. If the pathologist concentrates the specimen (such as cytospin), choose 88108 (Cytopathology, concentration technique, smears and interpretation [e.g., Saccomanno technique]). That’s the best code choice for the scenario you describe.

If the pathologist processes the specimen by a special method that "selectively enhances the cells" that you see on the slide (usually by a combination of removing unwanted cells and concentrating the desired cells), choose 88112. Code 88112 is often called "liquid based cytology," but that has nothing to do with whether you started with a liquid -- it has to do with how the specimen is processed. You might also see 88112 called thin-prep. You’d code 88112 if your lab prepares the cytology specimen by either of the commercially available cellular enhancement methods: ThinPrep™ or SurePath™