Pathology/Lab Coding Alert

Question: Our pathologist performed two intraoperative touch preps, one on specimen A, left sentinel lymph node, and one on specimen B, a second left sentinel lymph node. We billed 88333x2 but the payer denied the charge because the lymph nodes are from the "same lymph node basin." Is the correct coding 88333 and 88334?

Answer: You were right the first time. You should appeal the denial, because correct coding for the case is 88333 (Pathology consultation during surgery; cytologic examination [e.g., touch prep, squash prep], initial site) for specimen A and 88333 for specimen B.

"Initial site" in the 88333 code definition refers to the first touch prep from a single specimen. If the pathologist examines other touch preps from distinct sites on the same specimen, you should report each subsequent touch prep as +88334 (...cytologic examination [e.g., touch prep, squash prep], each additional site [list separately in addition to code for primary procedure]).

Documentation counts: Make sure your documentation identifies two, unique specimens as you stated in your question. Based on the payer's comment that the lymph nodes are from "the same lymph node basin," it's possible that the payer thinks this is a regional lymph node resection.

You may also ask the payer if they require a modifier in the case of two distinct specimens. Some payers won't accept billing units, but want you to list the additional specimen with modifier 59 (Distinct procedural service) or 76 (Repeat procedure or service by the same physician or other qualified health care professional).