Pathology/Lab Coding Alert

Question: Does the referring physician need to request the PAS/Alcian blue stain before the pathologist can perform the stain to rule out Barrett’s esophagus?

New York Subscriber

Answer: When a pathologist receives a specimen for examination and diagnosis, the referring physician does not have to specifically order ancillary tests such as special stains that the pathologist determines are necessary to reach a final diagnosis. According to the Medicare Benefit Policy Manual (IOM 100-02) chapter 15 section 80.6.5, an independent laboratory pathologist may perform additional tests that the referring physician does not specifically order under the following circumstances:

• These services are medically necessary so that a complete and accurate diagnosis can be reported to the treating physician/practitioner;
• The results of the tests are communicated to and are used by the treating physician/practitioner in the treatment of the beneficiary; and
• The pathologist documents in his report why additional testing was done.

That said, coding the periodic acid-Schiff (PAS)/Alcian blue stain can be difficult because it is a mixture of two stains. The PAS stain can help detect and definitively identify organisms such as fungi. Pathologists use the Alcian blue stain to assess cellular distortions indicative of Barrett’s esophagus, which is a chronic peptic ulcer of the esophagus.

Do this: If the pathologist examines a PAS/Alcian bluestained biopsy for the presence of micro-organisms and to investigate cellular changes that might be indicative of Barrett’s syndrome, report the professional component (by appending modifier 26, Professional component) of both stains. That means you should report the PAS evaluation as 88312 (Special stains; Group I for microorganisms [e.g., Gridley, acid fast, methenamine silver], including interpretation and report, each) and the Alcian blue evaluation as 88313 (… Group II, all other [e.g., iron, trichrome], except immunocytochemistry and immunoperoxidase stains, including interpretation and report, each) for the two-stain “cocktail” just as you would if the pathologist examined slides stained separately with PAS and Alcian blue. The physician work is fundamentally the same whether the stains are separate or mixed.

Resource: You can access the Medicare Benefit Policy Manual at www.cms.gov/manuals/Downloads/bp102c15.pdf.