Pathology/Lab Coding Alert

Chose the wrong code and you could lose your newfound tissue preparation pay. CPT 2010's + symbol and text instruction mean payers will expect you to report +88388 (Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies [e.g., nucleic acid-based molecular studies]; in conjunction with a touch imprint, intraoperative consultation, or frozen section, each tissue preparation [e.g., a single lymph node] [List separately in addition to code for primary procedure]) with certain other codes.

When the pathologist performs the special preparation as discussed in "Garner Molecular Studies Preparation Pay -- Here's How," you'll need to choose between two codes. Let our experts tell you the companion codes for +88388, as well as when you should expect to use 88387 (each tissue preparation [e.g., a single lymph node]) instead.

Add +88388 to Intraoperative Consults

When your pathologist performs macroscopic tissue exam and dissection for molecular testing preparation as part of an intraoperative consultation, you should use +88388 instead of 88387.

As the code definition espouses, you should list +88388 in addition to codes for intraoperative consultations, with or without touch prep or frozen section preparations. That instruction includes the following codes:

• 88329 -- Pathology consultation during surgery
• 88331 -- first tissue block, with frozen section(s),single specimen
• 88332 -- each additional tissue block with frozen section(s)
• 88333 -- Cytologic examination (e.g., touch prep, squash prep), initial site
• 88334 -- each additional site.

"Because +88388 is a macroscopic exam and dissection, you might use it in addition to 88329, which requires only a tissue gross exam," says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha.

Add-on caution: "Because +88388 is a formal 'add-on' code, you must report a primary service code from the range 88329-88334 on the same claim to get paid for the special preparation code," says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc. and publisher of the Pathology Service Coding Handbook, in The Villages, Fla.

Use 88387 For Non-Consultation Applications

For any situation other than intraoperative consultations, you should use 88387 to report the special macroscopic exam and tissue preparation for molecular studies.

The difference: "Report 88387, as opposed to +88388, when the pathologist performs the service outside of the operating room or 'frozen section suite' during specimen processing that is not part of an intraoperative consultation," Padget says.

That means you'd expect to see 88387 on a claim in addition to the appropriate surgical pathology code from the range 88302-88309 (Level x -- Surgical pathology,gross and microscopic examination ) even though 88387 is not an official add-on code.