Pathology/Lab Coding Alert

Question: Our pathologist examined the following stains for a liver biopsy: iron, trichrome, reticulin and PAS-D. I know that iron and trichrome are 88313, but which special-stain code should we use for reticulin and PAS-D?


Iowa Subscriber

Answer: You should choose the special-stain code based on the function of the stain--for microorganisms or other purposes:

• +88312--Special stains (list separately in addition to code for primary service); Group I for microorganisms (e.g., Gridley, acid fast, methenamine silver), each

• +88313--... Group II, all other (e.g., iron, trichrome), except immunocytochemistry and immunoperoxidase stains, each.

Pathologists may use Periodic Acid Schiff after diastase digestion (PAS-D) to identify fungal hyphae, and the correct code for this use is 88312.
 
But because your example is a liver biopsy, the pathologist is probably using the PAS-D stain to aid in liver-disease diagnosis by highlighting the basement membrane of intrahepatic bile ducts, for example. In that case, you should code the PAS-D as 88313.

Similarly, reticulin is a common stain for liver biopsy, highlighting collagen in the organ. As such, you should also report the reticulin stain using 88313.