Pathology/Lab Coding Alert

Question: When the cytotechnologist prepares cerebrospinal fluid for evaluation, we sometimes follow a direct smear by a cytospin because the direct smear shows inadequate cells. Can we bill for both the direct and concentrated smears? And can we bill separately for the stains we use, such as Quick Diff, Pap or Giemsa?


Ohio Subscriber

Answer: You should not report both the cerebrospinal fluid (CSF) direct and concentrated smears. Not only did the pathologist not interpret the direct smear because it was inadequate for evaluation, but Medicare considers performing both tests on the same specimen to be duplicate billing.

The codes for direct and concentrated smears for specimens such as CSF are 88104 (Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation) and 88108 (Cytopathology, concentration technique, smears and interpretation [e.g., Saccomanno technique]). You should report 88108 for your case, because the concentration provided the definitive slides for evaluation.

You should only report special-stain codes if the lab performs non-routine stains. Labs consider Pap, Giemsa, and Quick Diff to be routine cytology stains, so you should not bill separately for them. If you perform other stains that are not routine, such as acid fast or trichrome, report the appropriate code +88312-+88314 (Special stains [list separately in addition to code for primary service] ...) in addition to the cytology exam code.

Reader Questions and You Be the Coder were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark.