Pathology/Lab Coding Alert

Question: From a Medicare patient, we received a bronchial brushing labeled "right lower lobe" and a BAL specimen on the same day, which we processed as direct and concentrated smears. Can we code 88104 x 2 and 88108 for the concentration?

New York Subscriber

Answer: You should not list 88108 (Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation) and two units of 88104 (Cytopathology, concentration technique, smears and interpretation [e.g., Saccomanno technique) for this case. Instead you should code as follows:

• 88104 for the bronchial brushing, which the lab processed as direct smears.

• 88108 for the bronchoalveolar lavage (BAL) specimen, which the lab concentrated.

Although the pathologist examined both direct and concentrated smears from the BAL, Medicare, through its Correct Coding Initiative (CCI), restricts reporting 88104 and 88108 together for the same specimen. Rather, you should report the most extensive procedure -- in this case, the BAL concentration -- using 88108.

Snag: Because of the CCI edit, you'll have trouble getting paid for the bronchial brushing (88104) and concentrated BAL (88108), even though they are separate specimens, unless you use a modifier. Because these two services are for distinct specimens, you can override the CCI edit pair appending modifier 59 (Distinct procedural service) to 88104 (the column 2 code).