Pathology/Lab Coding Alert

Question: During a thyroid lesion FNA procedure, the surgeon asks our pathologist to evaluate whether the specimen contains enough cellular material for diagnosis. After examining the specimen and reporting that it is not adequate, the surgeon performs two more FNA passes and submits fluid in separate containers for each pass. The pathologist examines fluid from both passes and reports adequate material for examination. The pathologist then evaluates the specimen using ThinPrep. Should we report 88172 x 3, 88173, and 88112?

Washington Subscriber

Answer: No, you should not report this thyroid fine needle aspiration (FNA) case as you suggest.

First: You should report the adequacy check using 88172 (Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, first evaluation episode, each site) for the first time the pathologist performs the intraoperative evaluation for adequacy. Because the subsequent FNA passes are from the same lesion (same site), you should not list an additional unit of 88172.

Instead: For the subsequent FNA passes that the surgeon submits for intraoperative adequacy check, you should report +88177 (… immediate cytohistologic study to determine adequacy for diagnosis, each separate additional evaluation episode, same site (List separately in addition to code for primary procedure)). Despite the surgeon submitting two containers for different “passes,” you should report just one unit of +88177 in this case. That’s because the unit of service is the “evaluation episode.” Your pathologist receives and evaluates multiple passes in a single evaluation episode.

Exam: You correctly identify the code for the pathology FNA exam: 88173 (… interpretation and report). That’s the only code you need, regardless of how the pathologist processes the FNA specimen for examination. You should not list an additional code to describe the cytology method your pathologist uses, such as 88112 (Cytopathology, selective cellular enhancement technique with interpretation (eg, liquid based slide preparation method), except cervical or vaginal).

NCCI: Although you are correct that 88112 is the appropriate code for a non-gynecological ThinPrep cytology exam, you should not additionally report the code in this case. The National Correct Coding Initiative (NCCI) edits bundle 88173 with 88112 and other non-gyn cytopathology codes such as 88104 (Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation). Code 88173 describes the FNA exam, regardless of the cytology method used.