Pathology/Lab Coding Alert

Question: How do I report ova and parasite testing? The code for the smear is CPT 87177 , but should the concentration and trichrome stain be reported separately? I used to report the trichrome stain as +88312, but I am told we should use +88313. Is this correct?

California Subscriber

 
Answer: Testing for ova and parasites is reported as 87177 (Ova and parasites, direct smears, concentration and identification). This procedure involves a direct smear from a stool specimen, and a smear of concentrated feces through methods such as formalin concentration. Because testing for ova and parasites includes the concentration step as listed in the code definition, it is not appropriate to separately report 87015 (Concentration [any type], for infectious agents).
 
However, the trichrome stain for ova and parasite identification is separately reportable. Despite the fact that +88312 and +88313 are add-on codes in surgical pathology, they also describe special staining services for specimens other than surgical pathology tissues. There is no code in the microbiology section for this stain, so the service must be reported with one of the special stain codes from surgical pathology. A directional note in the microbiology section of the CPT manual states, For complex special stains, see 88312, 88313.
 
In the past, the note following 87177 in the CPT manual directed coders, For trichrome, iron hemotoxylin and other special stains, use +88312. Based on this, and the definition of +88312 as a Group I stain for microorganisms, the trichrome stain for ova and parasites was reported using +88312 (Special stains [list separately in addition to code for surgical pathology examination]; Group I for microorganisms [e.g., Gridley, acid fast, methenamine silver], each).
 
In CPT 2002, the note was changed to read, For trichrome, iron hemotoxylin and other special stains, use +88313. Although this code describes stains other than for microorganisms, trichrome is a listed example of this type of stain. Therefore, report the trichrome stain for ova and parasites using +88313 (... Group II, all other, [e.g., iron, trichrome], except immunocytochemistry and immunoperoxidase stains, each).
 
Although CPT directs the use of +88312 or +88313 for special stains on specimens other than tissue, some laboratories have reported denials from Medicare and third-party payers when reporting this stain with ova and parasites testing. The problem may be that a clinical laboratory has certification for microbiology and parasitology, but not for anatomic pathology. When the lab reports codes from the surgical pathology section, such as +88312 or +88313, payment may be denied. Labs can appeal the denials and ask the carrier to add these special stain codes to those allowed under the labs certification specialty.