Pathology/Lab Coding Alert

Question: Our lab received three brush slides along with a brush floating in fixative. We performed a cytospin on the fixative that contained the brush and prepared two more slides. Which codes should I use to report the processing, interpretation and reporting of these services?

Georgia Subscriber

Answer: The evaluation and interpretation of the three prepared brushings slides you received should be reported with 88104 (Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation). Notice that the code descriptor uses the plural "smears," indicating that multiple slides from the same cyto-pathology source should not be separately reported. However, the slides you prepared by concentrating the brush fixative warrant reporting an additional service. These two slides should be reported with 88108 (Cytopathology, concentration technique, smears and interpretation). Again, one unit of service is reported, regardless of the number of slides.

If you report this service to Medicare, these two codes are bundled under the Correct Coding Initiative (CCI) edits. Code 88104 is a component of comprehensive code 88108. This means that it is not appropriate to break the concentration service into two steps and report them separately (the cytospin as 88108 and the smear interpretation as 88104).

However, in your example, there are two separate services performed: the interpretation of direct brushing smears, and the concentration, preparation and interpretation of smears from the fixative. To override the CCI edit and receive reimbursement from Medicare for both services, append modifier -59 (Distinct procedural service) to the component code (88104).