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Pathology/Lab Coding Alert

Take the Consultation Challenge Take the Consultation Challenge

Published on Sun Jun 01, 2003

It's good to know the rules, but the proof is always in the pudding. Because three distinct code families describe pathology consultations, your challenge is to face a reallife lab report and code it correctly.

Test your understanding of pathology consultation codes (80500-80502, 88321-88323 and 88329-88332) by trying to code the following scenarios. Then see how you did by reading the expert's answers.

Scenario 1: A physician orders a lupus inhibitor panel and then requests that the pathologist review the findings to evaluate the implication of an abnormal result on the Russell viper venom test. The pathologist submits a written report indicating the clinical significance of the test results. How would you code this?

Coding for Scenario 1: In addition to the clinical lab test codes (for example, 85612, Russell viper venom time [includes venom]; undiluted; and CPT 85730 , Thromboplastin time, partial [PTT]; plasma or whole blood), you should report the consultation using CPT 80500 (Clinical pathology consultation; limited, without review of patient's history and medical records). "Because Medicare's National Correct Coding Initiative (NCCI) edits bundle 80500 as a component of 85612, you must append modifier -59 (Distinct procedural service) to the consultation code," says Elizabeth Sheppard, HT (ASCP), manager of anatomic pathology at Wake Forest University Baptist Medical Center in Winston Salem, N.C.

Scenario 2: A pathologist from an outside lab requests a second opinion on a hysterectomy, sending your lab three hematoxylin and eosin (H&E) slides, one iron-stain slide, and one CD5 antibody histochemistry slide. The referring lab also sends a tissue block. The pathologist at your lab examines the five submitted slides and prepares two more H&E slides from the tissue block, as well as two slides with different immunocytochemistry stains. The pathologist issues a written report to the referring lab.

How would you code this?

Coding for Scenario 2: Report the consultation service as 88323 (Consultation and report on referred material requiring preparation of slides). "Although the referring lab sent some pre-prepared slides, it also sent a block that your lab used to prepare additional H&E slides," says Laurie Castillo, MA, CPC, CPC-H, CCS-P, past member of the National Advisory Board of the American Academy of   Professional Coders and vice president of ambulatory services, Health Revenue Assurance Associates in Chapel Hill, N.C. Consequently, you shouldn't report the service as 88321 (Consultation and report on referred slides prepared elsewhere), Castillo says.

Nor should you report 88321 and 88323 together. "You should not report both consultation codes, because your pathologist provides only one consultation," Sheppard says. The unit of service for the consultation is the surgical case, which includes all submitted slides and tissue relating to the hysterectomy. Also, NCCI edits bundle 88321 as a component of 88323. NCCI lists this edit pair with modifier indicator "0," meaning that you cannot override the edit with any modifier, including modifier -59.

You should also report the special stains that your lab prepared using two units of 88342 (Immunocytochemistry [including tissue immunoperoxidase], each antibody). "Do not separately report the iron and CD5 special stains submitted to your lab by the referring pathologist because your lab did not perform that service," Sheppard says.

Scenario 3: During surgery, a pathologist receives a skin specimen for evaluation of margins. The pathologist examines frozen sections from two different tissue blocks and reports to the surgeon that the posterior margin is  incompletely excised. The surgeon later re-excises the posterior margin and sends it to the pathologist for frozen section evaluation.

Coding for Scenario 3: Report the original consultation as 88331 (Pathology consultation during surgery; first tissue block, with frozen section[s], single specimen) and 88332 ( each additional tissue block with frozen section[s]) because the pathologist examines frozen sections from two tissue blocks from the same specimen.

When the surgeon submits the re-excision, report an additional unit of 88331 because it represents a new specimen that is separately identified and submitted for evaluation and reporting. "Append modifier -59 to the second 88331 to avoid the appearance of duplicate billing," Sheppard says. The modifier indicates that the second specimen "represents a different session, different procedure, different site ... separate excision or separate lesion," as stated in CPT.

If the pathologist also performs the surgical pathology examination of the skin specimen and the re-excision specimen, also report two units of 88305 (Level IV - Surgical pathology, gross and microscopic examination, skin, other than  cyst/tag/debridement/plastic repair).

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