Pathology/Lab Coding Alert

Question: Our lab prepares thick and thin blood smears with a Giemsa stain for a patient with suspected malaria. The pathologist interprets the slides. How should we code this?

Maryland Subscriber

Answer: You should report the blood smear special stain exam as 87207 (Smear, primary source with interpretation; special stain for inclusion bodies or parasites [e.g., malaria, coccidian, microsporidia, trypanosomes, herpes viruses]).

Despite the fact that the pathologist examines both "thick and thin" smears -- concentrated and direct smears -- you shouldn't report 87207 twice. The unit of service for this code is "per stain" for a single specimen (primary source).

Do this: You can, however, capture the concentration step by reporting 87015 (Concentration [any type], for infectious agents) in addition to 87207.

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 example you-ve given. In this case, the lab uses Giemsa as a special stain for the sporozoan malarial organism, Plasmodium, not for bacteria, fungi, or cell types.

Distinguish technical and professional services: Code 87207 has a technical and professional component, so you-ll code differently depending on the billing entity.

If you-re billing only the pathologist's interpretation, append modifier 26 (Professional component) to 87207. You wouldn't list the technical concentration code (87015) if you-re billing for the physician only.

When billing this service for the lab technical work, report 87207-TC (Technical component) along with 87015 for the concentration.

Reporting 87207 without a modifier means that you-re billing globally -- claiming both the technical and professional portions of the work.