Pathology/Lab Coding Alert

Focus on site to get the pay you deserve.

When your pathologist performs a touch prep, you better know two wheres. Thats because both where in the building and where on the tissue can impact your code selection -- and your pathologists pay.

Understand the process: The pathologist performs a touch or squash prep by pressing a slide onto a surgical pathology specimen to make an imprint of cells for examination.

Where? Use 88333-88334 for the OR

If a surgeon asks your pathologist to come to the operating room to consult on a case during the patients procedure, thats a pathology consultation during surgery.

Sometimes the pathologist will perform one or more touch preps, examine the slides, and report the findings to the surgeon while the patient is still on the table. You should report touch prep(s) during surgery with one or more of the following codes:

" 88333 -- Pathology consultation during surgery; cytologic examination (e.g., touch prep, squash prep), initial site

" 88334 -- ... each additional site.

Dont miss: The pathologist doesnt have to perform all of the work in the operating room to report these codes.

The key to 88333 and 88334 is that the pathologist consults with the surgeon on the results of the touch prep while the patient is still in surgery, says R.M. Stainton Jr., MD, president of DoctorsAnatomic Pathology Services in Jonesboro, Ark.

Where? Report 88161-88162 in the Lab

When the pathologist examines a touch prep as part of a surgical pathology case workup in the lab, you should not use 88333 and 88334.

You should use cytology codes for touch preparations that arent part of a pathology consultation during surgery, says Ernest J. Conforti, MS, MBA, SCT(ASCP)MT, director of patient financial services for North Shore-Long Island Jewish Health System, headquartered in Great Neck, N.Y.

Choose one of the following codes based on the number of slides/stains:

" 88161 -- Cytopathology, smears, any other source; preparation, screening and interpretation

" 88162 -- & extended study involving over 5 slides and/or multiple stains.

Distinguish Specimen and Sites

Unlike with most surgical pathology codes, knowing the specimen isnt always enough for reporting 88333 and 88334. You might also need to know the site -- where on the specimen the pathologist touched the slide (s).

During surgery, the pathologist might examine touch preps from multiple, uniquely-identified sites on a single specimen, such as the medial and proximal margins. You should separately code each site (regardless of the number of slides from the site).

Do this: Report the first touch-prep site from a unique specimen as 88333. For each subsequent touch-prep site from the same specimen, you should list a unit of 88334.

Repeat as necessary. If the pathologist examines touch preps from a second distinct specimen, you should list the initial site code (88333) again, followed by 88334(s) for any subsequent sites.

Dont take multiple touch-prep sites lightly -- the pathology report must provide clear documentation that the pathologist evaluated unique sites.

Test Yourself With These Scenarios

Read the following examples, then try to code them before you read our experts solutions:

Scenario 1: The pathologist goes to surgery to consult on a breast resection. The surgeon points out sutures marking the medial and lateral margins of the lumpectomy specimen that he removed from the patients left breast.

After touching slides to a broad surface of each marked margin and examining them under the microscope, the pathologist reports his findings: lateral margin - no tumor present; medial margin - no tumor present. Based on these findings, the surgeon proceeds to close the surgical site.

Solution 1: The lumpectomy in this case represents the specimen, but the pathologist examines two different sites that you should code individually. Each site is medically significant to the patients care and treatment.

You should report the case as 88333 for the initial margin touch prep, plus 88334 for the touch prep from the second margin site.

Scenario 2: The surgeon requests a consultation during surgery for a patient with suspected lymphoma.

The pathologist examines touch preps from two separately identified lymph nodes and makes an immediate diagnosis of nodular sclerosing Hodgkins disease.

Solution 2: The pathologist performs touch preps on two separate specimens in this example: two distinct lymph nodes. Because 88333 for describes the initial site for each distinct specimen, you should code this case as 88333 x 2 lymph nodes. Because 88333 for describes the initial site for each distinct specimen, you should code this case as 88333 x 2.