Pathology/Lab Coding Alert

Question: How should we code a skin smear prepared for a Tzanck test and read by a cytotechnologist for inclusion bodies?

New York Subscriber

Answer: You might use one of two codes for the Tzanck test, depending on the circumstances. The test is a direct-smear preparation that involves a stain such as Wright or Pap. Physicians often take the smear from a skin lesion.
 
If a cytotechnologist processes and reads the smear to identify inclusion bodies, which could indicate the presence of a disease-causing organism such as herpes, you should report 87207 (Smear, primary source with interpretation; special stain for inclusion bodies or parasites [e.g., malaria, coccidia, microsporidia, trypanosomes, herpes viruses]).
 
Although a cytotechnologist often reports the results, noting the presence or absence of inclusion bodies, a pathologist may interpret the test results for this procedure. The pathologist should report the interpretation service by appending modifier 26 (Professional component) to 87207. This is the only code from the 87205-87210 code family for which Medicare allows you to use modifier 26.
 
If the physician interprets the test, Medicare pays $14.02 for the interpretation, paid on the Physician Fee Schedule. Medicare pays $8.37 for the technical work, paid on the Clinical Laboratory Fee Schedule.
 
But if the pathologist examines a skin smear from a broader perspective, evaluating more than just inclusion bodies, you should use a different code to report the test, even if it includes a Tzanck evaluation. That code is 88160 (Cytopathology, smears, any other source; screening and interpretation).
 
Within the cytopathology family, "any other source" refers to cytopathology specimens that are not fluids, washings, brushings, cervical or vaginal. That would include a direct smear from skin such as a vesicle or lesion. Medicare pays $18.95 for the global (technical and professional) 88160 service on the Physician Fee Schedule.
 
The College of American Pathologists clarified the nuances of coding for the Tzanck test in the June 2005 CAP Today. The coding instruction lists the Tzanck test as an example of 88160 but also states, "Direct evaluation of smears for cellular inclusions by microbiology is coded as 87207 when the evaluation is limited to mere reporting of the specific type of inclusion without consideration of etiology."