Pathology/Lab Coding Alert

"Clinical labs and anatomic pathologists use special stains to aid in microscopic examination of tissues or cells, but they shouldnt necessarily report the same codes for the same stain. Coders must know which CPT Codes to use based not only on the type of stain but also on the stain substrate and the reason for the procedure. Many special stain processes are described by 85535-85536, 87205-87207 and 88312-88313. Without properly applying these codes, laboratories may sacrifice payment for legitimate staining services, says William Dettwyler, MT-AMT, coding analyst for Health Systems Concepts, laboratory coding and compliance consultants in Longwood, Fla.

CPT 88312 -88313

Two special stain codes appear as add-on codes in the CPT surgical pathology section: 88312 (special stains [list separately in addition to code for surgical pathology examination]; group I for microorganisms [e.g., Gridley, acid fast, methenamine silver], each) and 88313 (... group II, all other [e.g., iron, trichrome], except immunocytochemistry and immunoperoxidase stains, each). In their most straightforward application, these codes describe the special staining of any surgical pathology tissue specimen. For example, an acid fast stain carried out on a transbronchial lung biopsy for diagnosis of disease such as tuberculosis would be reported as 88312, in addition to the surgical pathology service (88305, level IV surgical pathology, gross and microscopic examination, lung, transbronchial biopsy). Similarly, a trichrome stain to evaluate fibrosis observed in a liver biopsy (88307) is reported as 88313.

Despite the fact that 88312 and 88313 are add-on codes in surgical pathology, they also describe special staining services for specimens other than surgical pathology tissues. For example, if a trichrome stain for ova and parasites is carried out on a direct smear from a stool sample, the service is reported as 88312. There is no code in the microbiology section for this stain, so the service must be reported with one of the special stain codes from surgical pathology, Dettwyler says. A directional note in the microbiology section of the CPT manual states, For complex special stains, see 88312, 88313.

Another point coders find confusing about the ova and parasites stain is the fact that a trichrome stain is reported with 88312, even though trichrome is listed as an example under 88313. But in the ova and parasites stain, the trichrome is used to identify microorganisms, and should therefore be listed as 88312 because its definition lists group I for microorganisms, Dettwyler says. The trichrome stain described by 88313 is a tissue dye technique used to highlight connective tissue, muscle, cytoplasm and nuclei, and is therefore considered a group II stain.

Although CPT directs the use of 88312 or 88313 for special stains on specimens other than tissue, some laboratories have [...]