Pathology/Lab Coding Alert

Question: How should I code a consult report on two slides from the same date: slide A is colonic adenocarcinoma from a colon/ rectal biopsy, and slide B is metastatic colonic adenocarcinoma from a liver biopsy? I'd like help with the diagnosis and procedure coding.

Illinois Subscriber

Answer: Because the two slides are from the same colon cancer case on the same date, you should report a single consultation using 88321 (Consultation and report on referred slides prepared elsewhere).

Although the slides represent two specimens -- a rectal biopsy and a liver biopsy " the unit of service for pathology consultations is the case or accession, not the specimen. For that reason, you should not bill two units of 88321.

Regarding the diagnosis coding, you should report 154.0 (Malignant neoplasm of rectosigmoid junction) and 197.7 (Secondary malignant neoplasm of liver, specified as secondary). Use 154.0 instead of 154.1 (Malignant neoplasm of rectum) because the tissue report lists the specimen as a colon with rectum.

Remember Medicare restriction: Sometimes your pathologist might consult on two distinct cases from the same patient, such as slides from a mastectomy from several years ago and slides from a more recent breast biopsy. Although most payers would recognize this as 88321 x 2, Medicare limits payment to one unit of 88321.