Pathology/Lab Coding Alert

Question: We received slides and blocks from an outside institution for a consult on a patient diagnosed with colon cancer in 1996. The material included slides from 1996 and the patient's subsequent two-year follow-up colonoscopies for 1998, 2000, 2002 and 2004. The pathologist did not review patient records or prepare any additional special tests, such as immuno stains. How should we code the service?


Ohio Subscriber

Answer: You should bill five units of 88321 (Consultation and report on referred slides prepared elsewhere) because the slides are from five different surgeries on separate dates. The unit of service for consultation code 88321 is the accession, or surgical case, not the specimen. Depending on the original surgical date and body site that the slides came from, multiple slides or specimens from a single patient may comprise one or more accessions.

In your example, the slides represent excisions from five different dates, so you should report 88321 x 5 because different dates indicate different accessions.

Although your case involves the same body site, you should know that different body sites from the same date may also indicate different accessions. For example, if you receive slides for a consultation from a breast-lesion fine needle aspiration and a skin excision taken from the same patient on the same day, you should report two units of 88321.

Your carrier may require you to report multiple units of 88321 with modifier 59 (Distinct procedural service) to indicate that you performed separate consultations and are not double-billing.

You mentioned that you received slides and blocks, but evidently the pathologist did not prepare additional slides. If the pathologist had prepared additional slides from one surgery, such as the original 1996 colon resection, you would report that consultation as 88323 (Consultation and report on referred material requiring preparation of slides).

Because you stated that the pathologist did not review patient records aside from the pathology reports, you should not use 88325 (Consultation, comprehensive, with review of records and specimens, with report on referred material) for the service you describe.