Pathology/Lab Coding Alert

Question: We have three requisitions marked "slide consult" for three slides from another institution, all from the same patient and same date. The three slides are marked "left upper forehead," left lower forehead" and "left nose bridge." Does each slide warrant a consultation code?


Indiana Subscriber

Answer: No, the scenario you describe is not three slide consultations. Unlike other surgical pathology codes, the specimen is not the unit of service for the following consultation codes:

• 88321--Consultation and report on referred slides prepared elsewhere
• 88323--Consultation and report on referred material requiring preparation of slides
• 88325--Consultation, comprehensive, with review of records and specimens, with report on referred material.

Instead, the unit of service for these codes is the accession, which may include several specimens from a single surgical pathology or cytology case. In your case, the same date of service and the same organ system (skin) constitute a single surgical case, which you should report using 88321.

Only if you have two accessions--from two different dates or two unrelated organ systems--can you report two consultations for slides from the same patient. For example, you should report 88321 x 2 for consultation on slides from a lesion excision taken on one date and slides from a margin re-excision taken two days later.

But you should report only 88321 for consultation on slides from a hysterectomy and a related lymph node resection taken from the same patient on the same day.

Reader Questions and You Be the Coder were prepared with the assistance of R. M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark.