Pathology/Lab Coding Alert

Question: Our pathologist consulted on a thyroidectomy during surgery. He performed a frozen section for intraoperative tumor diagnosis, and separate touch prep for margin evaluation of the removed thyroid lobe. How should we code this? Arkansas Subscriber Answer: CPT provides distinct codes for intraoperative frozen sections and touch preps: - 88331 -- Pathology consultation during surgery; first tissue block, with frozen section(s), single specimen - 88332 -- - each additional tissue block with frozen section(s) - 88333 -- - cytologic examination (e.g., touch prep, squash prep), initial site - 88334 -- - cytologic examination (e.g., touch prep, squash prep), each additional site. When the pathologist performs frozen sections and touch preps on different sites of the same specimen as you described in your example, you can report both services together. Distinguish additional site: You should report your example as 88331 for the frozen section, plus 88334 for the touch prep on an additional site. You should not use 88333 for the touch prep because it is not the "initial site." A CPT text note following 88334 clarifies this coding: "For intraoperative consultation on a specimen requiring both frozen section and cytologic evaluation, use 88331 and 88334." Beware CCI edits: A Correct Coding Initiative (CCI) edit pair bundles 88331 and 88334, so you-ll have to use modifier 59 (Distinct procedural service) in this case to override the edit pair. Not all circumstances warrant reporting 88331 and 88334 together. Clarification from CCI indicates that you can only override the edit pair when the pathologist examines a frozen section and touch prep from two different sites on the same specimen or from two distinct specimens. Don't use cytology touch prep in surgery: When reporting touch preps that your pathologist performs during surgery as part of an intraoperative consultation, you should always use 88333 and 88334 to report the service. You should reserve 88161 (Cytopathology, smears, any other source; preparation, screening and interpretation) for touch preps that are not part of an intraoperative consult.