Pathology/Lab Coding Alert

Question: Our lab examines a smear from a BAL specimen, and then prepares a cell block from the remaining fluid. We examine both the smear and slides from the cell block, including a GMS stain on each. Should we consider this one specimen, meaning only one cytology exam and one special stain, or can we also bill for the cell block stain and exam?


California Subscriber

Answer: You should not consider this one specimen if a patient diagnosis requires the use of both procedures. Although the source for both is the bronchial alveolar lavage (BAL), the lab examines a direct smear (88104, Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation) and a cell block, which CPT lists as a separate specimen (88305, Level IV -- surgical pathology, gross and microscopic examination, cell block, any source).

Similarly, if you carry out a Gomori's methenamine silver (GMS) stain for fungus and Pneumocystis carinii on both the direct smear and the cell block, you can list each as a unit of 88312 (Special stains [list separately in addition to code for primary service]; Group I for microorganisms [e.g., Gridley, acid fast, methenamine silver], each).

Coders often find the cell block issue confusing. Because the initial smear exam and the cell block must come from a single source, coders often mistakenly think of the initial source as a -specimen.- In fact, CPT lists the cell block from any source as a unique specimen under 88305.

For example: The pathologist examines a bone-marrow aspirate (85097, Bone marrow, smear interpretation) and then prepares and examines a cell block from the remaining aspirate. You can code 88305 for the cell-block exam. You can also separately report special stains on the aspirate and the cell block because they represent different specimens.