Pathology/Lab Coding Alert

Question: Our cytopathology lab received a bladder washing specimen with the clinical diagnosis of "hematuria." After examining direct and concentrated smears, the pathologist noted an atypical finding of "reactive clusters of transitional cells." How should we code this?

Michigan Subscriber

Answer: The correct CPT code for the procedure is 88108 (Cytopathology, concentration technique, smears and interpretation [e.g., Saccomanno technique]).

Despite examining both direct and concentrated smears, you should not bill 88104 (Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation) in addition to 88108 for Medicare beneficiaries or insurers who follow Medicare rules.

That's because Medicare's Correct Coding Initiative (CCI) bundles cytology codes 88104-88112, stating that the agency considers different cytology preparations a "duplicate" service. That means you should not bill together different slide preparations from the same cytopathology specimen.

Diagnose this: You should report the atypical findings as the final diagnosis using 791.7 (Other cells and casts in urine) to describe the pathologist's findings of "reactive clusters of transitional cells." The finding is more specific than the ordering diagnosis of visual hematuria (599.71, Gross hematuria).