Pathology/Lab Coding Alert

Question: Our pathologist examined renal biopsy A with an H&E stain and renal biopsy B with an immunofluorescent stain. Should we report 88305 x 2 in addition to a special stain code?

North Carolina Subscriber

Answer: To answer the question, you have to know with certainty if you-re dealing with one kidney biopsy specimen, or two. Because of the way they-re processed,renal biopsies can often be a source of confusion on this point.

Here's why: For hematoxylin and eosin (H & E) staining, the pathologist processes the kidney tissue as a paraffin block. But for immunofluorescent (IF) stains, the pathologist often snap freezes a portion of kidney tissue instead of imbedding it in paraffin. That means you can expect specimen processing to divide a standard renal biopsy into two pieces.

Caution: If biopsy -A- and -B- in your example represent the two portions of a single renal specimen, you should only report one unit of 88305 (Level IV -- Surgical pathology, gross and microscopic examination, kidney, biopsy). You can list only two units of 88305 if you have strong documentation that the surgeon submitted two distinct, separately identified kidney biopsies.

Add on stain: Additionally, you should bill for the IF stain using the appropriate code, such as 88346 (Immunofluorescent study, each antibody; direct method) or 88347 (- indirect method). Don't separately report the H & E stain, because that is the standard stain for processing the paraffin block, and code 88305 includes the standard stain.

Clarify reporting: If you use a labeling system such as -A- and -B- to identify individual specimens, make sure all involved personnel are aware of this potential pitfall and resist using the same nomenclature for varied processing of tissue blocks.