Pathology/Lab Coding Alert

Question: We received two direct-smear slides from a bronchial brushing along with the brush in cytolyt. We made a thin-prep slide from the cytolyt, Pap stained the two direct smears, and examined all three slides. What is the proper coding?

Delaware Subscriber

Answer: The answer hinges on the payer. The Correct Coding Initiative (CCI) policy manual states that you must report only the most extensive code from a group of related services. The theory is that the related services provide the same diagnostic information, so only one procedure is medically necessary.

For cytopathology services, CCI excludes reporting direct smears (88104, Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation) and thin-prep smears (88112, Cytopathology,selective cellular enhancement technique with interpretation [e.g., liquid based slide preparation method], except cervical or vaginal) for the same specimen.So if the payer is Medicare or a private payer that requires you to follow CCI bundling rules, you should report your service as 88112.

Other way: The AMA and the College of American Pathologists recognize different cytopathology preparations (such as direct and concentrated smears) from a single specimen as distinct services. If your payer adheres to this interpretation, you should report your service as 88104 and 88112.