Pathology/Lab Coding Alert

The codes are new, but the coding principles remain the same. "Just as last year, fine needle aspiration (FNA) and bone marrow aspiration or biopsy involve multiple steps and are reported using separate codes for each procedure," explains R.M. Stainton, MD, president of Doctors' Anatomic Pathology in Jonesboro, Ark.
 
Depending on the services provided for a specific clinical situation, separate codes may also be reported for specimen collection and pathologic evaluation as well as adjunct procedures such as cell blocks and special stains. Coding is further complicated if different billing entities perform the technical and professional components of some of these services, requiring the use of modifiers.
Bone Marrow Aspiration
Bone marrow aspiration involves removing a small amount of fluid (aspirated cells) from the bone marrow through a needle attached to a syringe. "Although the pathology code for this service was deleted in CPT Codes 2002 (85095), the pathologist should still report the service if he or she provides it, using the new code added to the surgery section (38220, Bone marrow aspiration)," Stainton says. The placement of the code in the surgery section does not mean that only a surgeon can report the procedure.
 
A pathologist examines and evaluates the specimen, whether or not he or she was the physician who removed the aspirate. The evaluation is reported with CPT 85097 (Bone marrow, smear interpretation). "If the pathologist collects and examines the specimen, 38220 and 85097 should be reported," Stainton says.
 
Code 85097 includes a technical and professional component. The technical component involves the preparation of smears by the cytotechnologist, while the professional portion of the service is the interpretation of the smears by the pathologist. If the entire service is carried out by the same billing entity, report 85097 without modifiers. For some payers, modifiers must be used if the laboratory and pathologist bill separately. For Medicare and some other payers, the lab reports 85097 with modifier -TC (Technical component), and the pathologist reports 85097 with modifier -26 (Professional component).
 
Full evaluation of the bone marrow aspirate often entails additional services, Stainton says. "After the smears are prepared, the remainder of the sample is often processed as a cell block." The pathologist's evaluation of the cell block would be reported as 88305 (Level IV- surgical pathology, gross and microscopic examination, cell block, any source) in addition to 85097.
 
Special stains represent an additional service that is commonly carried out for bone marrow aspirate and is separately reportable. "For example, myeloperoxidase or Sudan black B stains are often used in the evaluation of leukemia patients to provide improved cytologic detail," Stainton says. Report 88342 (Immunocytochemistry [including tissue immunoperoxidase], each antibody) for the stains in addition to codes for other services provided. [...]