Pathology/Lab Coding Alert

Question: We have a CSF specimen sent for cytology that we processed as a direct smear and as a liquid-based preparation to remove contaminants and enhance the specimen. Can we bill for both preparations?


Wisconsin Subscriber
Answer: The answer depends on your payer. Cerebral spinal fluid (CSF) is a non-gynecological fluid cytology specimen, which means you should select from codes 88104-88112 to describe the specimen exam.

Except for the CPT note, -Do not report 88112  with 88108,- long-standing AMA instruction allows  you to report each non-gyn liquid cytology preparation as a distinct service. In other words, if the pathologist needs to examine both a direct smear and a concentrated smear to reach a diagnosis, you could bill separately for each preparation--88104 (Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation) and 88108 (Cytopathology, concentration technique, smears and interpretation [e.g., Saccomanno technique]).

For payers not following Medicare rules: Under the AMA guidance, your example would warrant reporting 88104 and 88112 (Cytopathology, selective cellular enhancement technique with interpretation [e.g., liquid based slide preparation method], except cervical or vaginal).

Red flag: CMS has established different criteria for billing these codes, which you-ll need to follow for Medicare or any payers that use the same rules. The Correct Coding Initiative (CCI) edits bundle codes within the 88104-88112 group, meaning that you cannot bill different preparations together for the same specimen. The CCI manual instructions state that Medicare considers different cytology preparations a -duplicate- service. If the pathologist uses two preparations, you should bill only for the more comprehensive procedure.

For Medicare: That means you should bill your example to Medicare as 88112. You should not additionally report 88104. Even though using modifier 59 (Distinct procedural service) would override the edit pair, you should not use 59 when you-re billing for one specimen, as in your example.