Pathology/Lab Coding Alert

Question: During a needle core breast biopsy procedure, the surgeon asks our pathologist to evaluate a touch prep. The pathologist reports the findings intra-operatively, then provides the surgical specimen exam at a later time. The cytology tech screens the touch prep slide post-procedure, and the pathologist evaluates and reports those findings with reference to the intraoperative touch prep and the specimen exam findings. Can we code separately for the cyto-tech's and pathologist's postoperative touch prep review? Ohio Subscriber Answer: No, you cannot separately charge for the postoperative review of the intraoperative touch prep by the cytology technician or the pathologist. Reviewing the findings together is a quality measure. Action: The appropriate codes for the case are as follows: - 88333 -- Pathology consultation during surgery; cytologic examination (e.g. touch prep, squash prep), initial site. - 88305 -- Level IV -- Surgical pathology, gross and microscopic examination, breast, biopsy, not requiring microscopic evaluation of surgical margins. Pitfall: Trying to separately report the postoperative touch prep review using another code such as 88161 (Cytopathology smears, any other source; preparation, screening and interpretation) would be fraudulent. Medicare bundles the two codes with a national Correct Coding Initiative (CCI) edit to ensure that you don't report both codes for the same specimen. You should reserve 88161 for touch preps that your lab processes that do not involve an intraoperative consultation.