Pathology/Lab Coding Alert

Question: If the pathologist bills CPT 88173 for interpretation of fine needle aspirates (i.e., bone marrow, thyroid, etc.), what code should the hospital use for the technical component? The code needs to cover staining of slides already prepared and slides that need to be made from aspirate fluid received.

Kansas Subscriber

Answer: For the technical component (TC) of a fine needle aspirate (FNA), the hospital should use 88173 (cytopathology, evaluation of fine needle aspirate; interpretation and report) because this procedure code has a specific technical component associated with it. The hospital can bill it without the modifier -TC because on form UB-92 a hospital can be paid only for the TC portion of that code. The pathologist will be billing code 88173-26 (professional component) for the professional component of this code. This will not prevent the hospital from using this same code for its TC portion.

Remember that billing for the TC of pathology services changes under certain circumstances. The billing of this portion will need to be performed as the ambulatory payment classification (APC) rules dictate.

Billing for the bone marrow codes 85095 (bone marrow; aspiration only), 85097 ( smear interpretation only, with or without differential cell count) or 85102 (bone marrow biopsy, needle or trocar) is different from billing for FNA in that there is no listed TC available in the resource based relative value scale (RBRVS). However, there are payments for the facility for these codes under APCs. Codes 85095 and 85102 are assigned to APC code 0003, while 85097 is listed with APC 0344.

- Answers to "You be the Coder" and "Reader Questions" provided by William K. Dettwyler, MT, an independent coding analyst in Salem, Ore., and a member of AMT, CLMA and AACC.