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Pathology/Lab Coding Alert

Reader Question:

Special Stains Not Clear

Published on Tue Jul 01, 2003

Question: Is it possible to get a complete list of stains that we should report as either CPT 88312 or 88313? The CPT definitions give examples, but we often see stain names in the pathology report that we do not know how to classify.

Illinois Subscriber

Answer: An exhaustive stain list is not available because there are so many stains, and the pathologist may use the same stain for different purposes. The distinction between the two codes you mention is the reason for the stain, not the specific stain, as you can see from the definitions that follow:

+88312 Special stains (list separately in addition to code for surgical pathology examination); Group I for microorganisms (e.g., Gridley, acid fast, methen-amine silver), each

+88313 ... Group II, all other (e.g., iron, trichrome), except immunocyto-chemistry and immunoperoxidase stains, each.

For example, pathologists often use the trichrome stain to highlight connective tissue, muscle, cytoplasm and nuclei. As such, it is a group II stain and you should report it as 88313. But microbiologists sometimes use a trichrome stain to identify ova and parasites in a direct stool smear. Although the definition for 88313 includes trichrome as an example, you should report a trichrome stain for microorganisms as 88312.

That being said, there are some commonly used stains that you will often see as either group I or group II. Although far from exhaustive, perhaps the following list of common 88312 stains and descriptions of situations when pathologists would use them will help:

  • Acid Fast often used to identify acid-fast bacilli involved in diseases such as tuberculosis

  • Methenamine Silver, Periodic Acid Shift (PAS), Gridley commonly used to identify fungi in tissue samples

  • Brown Brenn used for differential staining of Gram-negative and Gram-positive bacteria in tissue

  • Steiner commonly used to identify Helicobacter pylori in specimens such as gastric biopsy.

    Pathologists use these common 88313 stains in the following situations:

  • Iron typically to evaluate iron stores in the bone marrow, especially for the diagnosis of iron deficiency anemia

  • Trichrome often used for tissue biopsy when the pathologist observes fibrosis

  • Congo Red commonly used to diagnosis tumors and other disorders associated with amyloid deposits

  • Elastic Stain frequently used to examine arterial specimens.

    Reader Questions and You Be the Coder were prepared with the assistance of Laurie Castillo, MA, CPC, CPC-H, CCS-P, past member of the National Advisory Board of the American Academy of Professional Coders and vice president of ambulatory services for Health Revenue Assurance Associates in Chapel Hill, N.C.

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