Pathology/Lab Coding Alert

Question: If a pathologist receives a bone marrow paraffin block and cuts sections from it, staining for hematoxylin and eosin, CD43, CD3 epsilon, CD20, CD79A, and cyclin D, which codes would be used for the professional and technical components?

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Answer: The hematoxylin and eosin (H&E) stain is the most commonly applied stain for microscopic tissue examination. As such, almost any microscopic tissue examination will incorporate this stain, so it is a part of the surgical pathology service. The surgical pathology evaluation of a bone marrow biopsy is reported as 88305 (Level IV Surgical pathology, gross and microscopic examination, bone marrow, biopsy), which would include the H&E stain.
 
The other stains listed are immunocytochemistry markers that would typically be used for the diagnosis of a lymphoma such as myelodysplastic syndrome. Each immunocytochemistry stain is reported as 88342 (Immunocytochemistry [including tissue immunoperoxidase], each antibody). In the example given, 88342 x 5 would be reported.
 
Codes 88305 and 88342 include a technical and professional component. The technical component includes the preparation of the slide, accounting for expenses such as histotechnician salary and lab supplies. The professional component is the pathologist's interpretation of the slides.
 
The professional and technical portions are referred to as the "global service." If the same provider performs the technical and professional component, the CPT codes are reported without modifiers.
 
Very often, the laboratory owns the equipment, purchases the supplies and pays the personnel involved in the technical portion of the test, while an independent pathologist interprets the slides. When the two portions of the same service are carried out by different billing entities, each must report its portion of the service with the appropriate modifier.
 
The pathologist uses modifier -26 (Professional component), while the lab uses HCPCS modifier -TC (Technical component). For example, the immunocytochemistry stain is reported by the lab as 88342-TC, and the pathologist reports 88342-26.