Pathology/Lab Coding Alert

New CPT code raises more questions than it answers Although the code is only months old, controversy already surrounds 88112 (Cytopathology, selective cellular enhancement technique with interpretation [e.g., liquid- based slide preparation method], except cervical or vaginal), introduced in CPT 2004.
 
The example given in this non-cervical/vaginal cytopathology code - liquid-based slide preparation method - might lead you to report 88112 for all non-gyn thin layer preparations. But until the AMA provides further direction, you'd better report 88112 only for non-gyn liquid cytology that includes the process described in the code definition - selective cellular enhancement technique.
 
One thing is certain, "Code 88112 provides a method-specific code for at least some thin layer preparations from non-gyn sources, just as cervical sources have had for years," says Beth McDevitt, CPC, coding and audit specialist with Pathology Service Associates LLC (PSA), a nationwide organization headquartered in Florence, S.C., that provides coding, compliance, billing and marketing services to pathologists. Choose Code by Method Code 88112 describes cytopathology smears involving concentration and cellular enhancement from sources such as urine and cerebral spinal fluid or bronchial specimens. It joins other method-driven codes for non-gynecological cytopathology sources. CPT already had codes in place for filter method and concentration techniques:

   88106 - Cytopathology, fluids, washings or brushings, except cervical or vaginal; filter method only with interpretation
   88107 - ... smears and filter preparation with interpretation
   88108 - Cytopathology, concentration technique, smears and interpretation (e.g., Saccomanno technique). Codes 88106-88107 specify the source as fluids, washings or brushings. Code 88108 may refer to concentration of a sample from these sources or other non-gynecological sources such as sputum. Concentration methods include cytospin and Saccomanno technique. Prior to 88112's introduction, coders reported non-gyn thin layer preparations using code 88108.
 
"The difference between 88108 and 88112 is that in addition to concentration, the 88112 technique involves selective enrichment of the desired cells," McDevitt says. "That may involve removing background debris such as blood cells, mucous, or inflammatory cells that otherwise obscure the cells the pathologist needs to evaluate." This "selective cellular enhancement" is at the heart of the controversy.
 
"The 88112 code definition is a bit confusing because it uses 'liquid-based slide preparation' as an example, but at the same time, not all such preparations result in selective cellular enhancement," says Elizabeth Sheppard, HT (ASCP), manager of anatomic pathology at Wake Forest University Baptist Medical Center in Winston Salem, N.C.
 
Not every specimen contains debris that a liquid-based method must remove to selectively "enhance" cells for interpretation. Yet commercial liquid-based cytology such as SurePath or ThinPrep has the ability to concentrate diagnostic material and remove background contaminating debris by washing, filtration, centrifugation and/or gravity dispersion.
 
In its "Rationale" for code 88112 published in CPT Changes 2004 [...]