Pathology/Lab Coding Alert

Question: If the lab prepares a Wrights stain slide for a bone marrow aspirate for the pathologist, is there a separate code that can be billed, such as 87205? Or is this stain bundled into the technical component of 88305? The lab personnel only stain the slides; they do not interpret the stained slides. Also, if the laboratory prepares the differential cell count of the bone marrow aspirate for the pathologist, can the lab bill the technical component of 85097, since the pathologist prepares the final interpretation and report?

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Answer: You should not report 87205 (smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types) for a bone marrow aspirate, as this code describes the preparation, staining (Gram or Giemsa) and interpretation of smears from a primary source such as sputum or cerebrospinal fluid. Nor should you report any special stain code for the Wrights stain of a bone marrow aspiration because this is the standard staining technique used to prepare the smears. Although, based on the note in CPT 2001, special stains can be reported in addition to 85095 (bone marrow; aspiration only) and 85097 (bone marrow; smear interpretation only, with or without differential cell count), the Wrights stain is not a special stain, but is considered the basic stain for bone marrow aspiration smears.

You should not report 88305 (level IV surgical pathology, gross and microscopic examination, bone marrow, biopsy) for the examination of a bone marrow aspirate. This code refers to a bone marrow biopsy, meaning intact tissue obtained through a needle or trocar, for example, rather than the fluid containing cells obtained by aspiration. Instead, 85097 should be used to describe the evaluation of a bone marrow aspirate. You do not code separately for the differential cell count because that service is included in 85097. In other words, 85097 describes the evaluation of bone marrow aspirate whether or not a differential cell count is conducted.

To clarify coding for bone marrow aspiration, the service is broken down into two parts and reported using two codes. The bone marrow aspiration, which involves inserting a needle and aspirating cells from the marrow and preparing smears, is reported using 85095. The interpretation of the smears, including differential cell count, if done, is reported using 85097.

Answered by R.M. Stainton Jr., MD, president of Doctors Anatomic Pathology Services, an independent pathology laboratory in Jonesboro, Ark.