Pathology/Lab Coding Alert

Question: Our pathologist received a consultation request from an outside laboratory on slides prepared from several different skin specimens. All specimens had the same date of service, and we received them as one accession. However, each specimen is individually identified: A) right cheek skin biopsy, B) left thigh skin punch biopsy, and C) right wrist skin biopsy. Should we code this as one or three units of 88321?

Washington, D.C., Subscriber
 
Answer: You should report one unit of 88321 (Consultation and report on referred slides prepared elsewhere) for the service you describe. Although you describe different specimens, the specimen is not the unit of service for pathology consultations on referred material (88321-88325). Rather, the unit of service for these consults is the surgical or cytological case, or the accession.

Because the pathologist received slides from these three specimens together as one accession, representing one surgical case taken on the same day, you should code the case as 88321. If the pathologist received specimens taken from different dates, or representing different body systems and thus different surgical cases, you could report multiple units of 88321.

Coders often find pathology consultation coding confusing because surgical pathology codes 88302-88309 (Surgical pathology, gross and microscopic examination) use the specimen as the unit of service. So, if the pathologist examines three separately identified skin biopsies taken from the same patient on the same day, you would report three units of 88305 (Level IV - surgical pathology, gross and microscopic examination, skin, other than cyst/tag/debridement/plastic repair).

But if the pathologist reviews these same three specimens as a referred consultation, you should report only one unit of 88321. -- Reader Questions were prepared with the assistance of Laurie Castillo, MA, CPC, CPC-H, CCS-P, president of Professional Coding and Compliance Consulting in Manassas, Va.