Pathology/Lab Coding Alert

Question: A patient with myeloma was having an unrelated knee replacement surgery. During the operation, the pathologist was called to prepare an incidental bone marrow smear examination, because the surgeon determined that while the patient was open may be a good time to harvest. The pathologist did everything except stick the patient; he prepared and examined the smears and slides. How should I code this?

Georgia Subscriber

Answer: You should report the pathologist's exam and interpretation of the bone marrow smears as 85097 (Bone marrow, smear interpretation). The pathologist performed only the interpretation, not the bone marrow collection, which you should always report separately.
 
The physician who performed the bone marrow collection should report that service with one of the following codes: 38220 (Bone marrow; aspiration only), 38221 (... biopsy, needle or trocar) or 38230 (Bone marrow harvesting for transplantation). A pathologist may perform this service and report these codes even though they are in the surgery section. In the example you give, however, it was the surgeon who collected the bone marrow specimen, not the pathologist.
 
Although it is unclear from your question, if the surgeon requested a consultation from the pathologist during surgery, you should report the consultation as a separate service. For example, if the pathologist consulted on the bone marrow findings during surgery to determine if harvesting was appropriate, you would report 88329 (Pathology consultation during surgery) in addition to 85097 for the smear interpretation.