Pathology/Lab Coding Alert

Question: When the pathologist receives material from another physician for slide preparation and interpretation, should we bill only 88323? I received a suggestion to bill 88323-26 and 88305-TC and would appreciate clarification?

AAPC forum participant

Answer: Your question doesn’t make clear whether the pathologist receives material from another physician as a consultation. If the order confirms a request for consultation, and the pathologist prepares and interprets slides and provides a report back to the referring physician, you should bill this as 88323 (Consultation and report on referred material requiring preparation of slides).

Modifiers: Code 88323 includes the technical work of preparing the slides and the professional service of interpretation. If your lab performs just one part of that service, you could bill 88323 with modifier TC (Technical component…) for the slide prep, or modifier 26 (Professional component) for the interpretation. If the service your pathologist provides includes both components, you should not use one of these modifiers.

Code 88305 (Level IV - Surgical pathology, gross and microscopic examination …) includes the initial gross and microscopic evaluation of a tissue specimen, specifically a type of specimen listed in the code, such as colon, biopsy. The situation you describe does not fit the 88305 code descriptor.

Plus: The National Correct Coding Initiative (NCCI) edits lists 88305 as a column 2 code for 88323. You should not bill both codes together for a single specimen.