Pathology/Lab Coding Alert

Question: Our pathologist received a skin lesion excision specimen for which the surgeon requested a determination if the surgical margins were clear, before he closed. The pathologist prepared and examined four touch preps on the margins to ensure that the margins were clear. We billed 88161 x 4, but received a denial. Is our coding correct, or could the problem be that we billed the touch preps with the surgical pathology exam, 88305?

Wisconsin Subscriber

Answer: The procedure your pathologist performed is an intraoperative consultation using touch preps to evaluate the tissue margins. You should not report 88161 (Cytopathology, smears, any other source; preparation, screening and interpretation) for a touch prep performed as part of an intraoperative consultation.

Instead, you should turn to the following two codes to bill intraoperative touch preps.

• 88333 — Pathology consultation during surgery; cytologic examination (e.g., touch prep, squash prep), initial site
• +88334 — … cytologic examination (e.g., touch prep, squash prep), each additional site (List separately in addition to code for primary procedure)

Because your pathologist examined four sites (distinct margins) of a single specimen (the excised lesion), you should bill the case as 88333 for the initial site, plus +88334 x 3 for the other three margin touch preps.

Part of the problem with the denial may have indeed involved the fact that you billed 88161 with 88305 (Level IV - surgical pathology, gross and microscopic examination, skin, other than cyst/tag/debridement/plastic repair), because there is a Correct Coding Initiative (CCI) edit that prohibits reporting those services together. But the bigger issue is that the 88161 is not the appropriate code for a touch prep that is part of an intraoperative touch prep service.