Pathology/Lab Coding Alert

Question: The lab performs direct and concentrated blood smear Giemsa stain to rule out malaria, and the pathologist interprets the stains. Should we report the pathologist's interpretation using consultation code 80500 in addition to the stain code?

New Mexico Subscriber

Answer: No, you should not bill 80500 (Clinical pathology consultation; limited, without review of patient's history and medical records) in addition to the stain code (87207, Smear, primary source with interpretation; special stain for inclusion bodies or parasites [e.g., malaria, coccidian, microsporidia, trypanosomes, herpes viruses]).

Here's why: Code 87207 is a "global code" that includes both the technical and professional components when you bill the code without a modifier. That means the pathologist's interpretation is included in the service, and you should not separately bill the interpretation using a consultation code.

If you're billing only the pathologist's interpretation, append modifier 26 (Professional component) to 87207. When billing this service for the lab technical work, report 87207-TC (Technical component). Reporting 87207 without a modifier means that you're billing globally -- claiming both the technical and professional portions of the work.

Add concentration: You shouldn't bill 87207 twice for the same specimen, even though the pathologist examines the stain for direct and concentrated smears. You can, however, bill for the concentration step using 87015 (Concentration [any type], for infectious agents).

Don't let Giemsa fool you: Even though a related code lists "Giemsa" in the definition, you should not report 87205 (Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types) for the malaria test. In this case, the lab uses Giemsa as a special stain for the sporozoan malarial organism, Plasmodium, not for bacteria, fungi, or cell types.