Pathology/Lab Coding Alert

Question: You stated in a past issue of Pathology/Lab Coding Alert that a fine needle aspiration (FNA) smear interpretation includes a technical component and a separate professional component for the pathologist's service. In our laboratory, cytotechnologists do the evaluation, interpretation and report for FNAs. Can we bill for 88173 as a technical rather than a professional procedure?

New Jersey Subscriber

Answer: Code 88173 (Cytopathology, evaluation of fine needle aspirate; interpretation and report) encompasses both a technical component, for the smear preparation and cytotechnologist's screening, and a professional component, for the pathologist's interpretation. According to the Medicare Carriers Manual, Part 3 Section 15020, there are "specific cytopathology, hematology and blood banking services that have been identified to require performance by a physician." Code 88173 is on that list, which is why Medicare's Physician Fee Schedule allows you to report the code with modifier -TC (Technical component) and modifier -26 (Professional component). The standard of care calls for the pathologist to interpret the FNA. You can bill the technical component of 88173 as performed by the cytotechnologist, but you can bill the professional component only if the pathologist performs the interpretive services.

Reader Questions and You Be the Coder were answered and/or reviewed by Stephen Yurco III, MD, partner and pathologist at clinical Pathology Associates in Austin, Texas; and R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark.