Pathology/Lab Coding Alert

Question: What is the correct date of service when our pathologist performs a second-opinion consultation on tissue or slides sent from another institution?


Michigan Subscriber
Answer: Although almost all laboratory and pathology services use the date of specimen collection as the date of service, pathology consultations on referred material are different. The codes are as follows:

• 88321--Consultation and report on referred slides prepared elsewhere

• 88323--Consultation and report on referred material requiring preparation of slides

• 88325--Consultation, comprehensive, with review of records and specimens, with report on referred material. By definition, these codes involve material referred from another institution, which means that the consulting pathologist does not perform a service that is part of the original specimen examination and diagnosis. As such, the consulting pathologist's work has nothing to do with the original specimen collection date, which could have been days or years prior to the consultation.

To further confuse the issue, the specimen is not the unit of service for consultation codes 88321-88325. Rather, the unit of service is the surgical or cytological case that the referring pathologist sends for a consultation. For instance, if the referring physician sends slides from three separately identified skin lesions for a consultation, you should report only one unit of 88321 because this represents one surgical case.

Medicare provides three guidelines to labs for selecting the proper date of service:

1. The date of service for a specimen is the date of specimen collection.

2. If the specimen collection takes more than 24 hours, use the collection end-date as the date of service.

3. For archived specimens--those that have been stored more than 30 days--you should use the date of retrieval as the date of service.

Although the guidelines do not specifically address the special circumstances of pathology consultation codes 88321-88325, they do provide some sense of a reasonable solution to the dilemma. Pathologists commonly use the date that they receive the referred material and the consultation request as the date of service.
 
Although not used as the date of service, the pathology report could include the original specimen-collection date and the name of the referring pathologist to aid in tracking information.