Pathology/Lab Coding Alert

Question: When our pathologist receives a tissue block with a request for consultation, he sometimes prepares and evaluates additional slides, including special stains. We're receiving denials when we report the consultation and stain codes together. Are we allowed to report these codes together, and if so, how can we avoid the denials?


Maine Subscriber

Answer: Yes, you can report together a consultation code and special stain codes when your pathologist prepares and examines the special-stain slides from tissue. You cannot report the services together if the pathologist simply examines special-stain slides that the ordering physician sends with the consult request.

Do this: For the pathology consultation on submitted tissue, report 88323 (Consultation and report on referred material requiring preparation of slides). When the pathologist prepares and examines special-stain slides from the submitted tissue, also report the appropriate stain code, such as +88312 (Special stains [list separately in addition to code for primary service]; Group I for microorganisms [e.g., Gridley, acid fast, methenamine silver], each) or +88313 (...Group II, all other [e.g. iron, trichrome], except immunocytochemistry and immunoperoxidase stains, each).

Because the National Correct Coding Initiative (NCCI) pairs 88323 with both 88312 and 88313, you'll have to use modifier -59 (Distinct procedural service) to override the edit pair. The NCCI policy manual states that, "CPT codes 88312, 88313 and 88342 may be reported with CPT code 88323 if the provider performs and interprets these stains de novo."

You would not report the stain codes with pathology consultation code 88321 (Consultation and report on referred slides prepared elsewhere) even if the slides include special stains, because 88321 describes evaluation of slides that another lab prepared.

- Reader Questions were prepared with the assistance of Laurie Castillo, CPC, CPC-H, CCS-P, owner of Castillo Consulting in Manassas, Va.