Pathology/Lab Coding Alert

Question: We set up two tissue cultures from the same bone marrow specimen with two different lot numbers. If we have an abnormality in one culture, we need the second to verify or rule-out that abnormality.

Or, when we set up two tissue cultures from a bone marrow specimen, we might need the second one for mitogen for the pathologist to reach a final diagnosis for lymphoid cancer.
Can we report two tissue cultures in each of these cases? Most payers accept the bill when we do so, but one payer rejects our claims.

Tennessee Subscriber

Answer: No, you should not report two units of 88237 (Tissue culture for neoplastic disorders; bone marrow, blood cells) in these cases.

It’s quite common for cytogenetic labs to initially set up two tissue cultures in case the second one is needed, but you should bill only one unit for a single specimen.

Here’s why: The culture charge code, in this case, 88237, includes whatever process the lab performs to accomplish the service. If the lab needs the second culture for verification, it’s still part of the culture service from the original specimen.

As with anatomic pathology, the specimen is the unit of service in this cytogenetics example. Even in clinical laboratory tests, the initial specimen is typically the unit of service. For instance, if the lab needs to dilute a specimen and run a test again to determine a final result, the lab doesn’t charge again for the test.

The fact that many of your payers are paying for two units doesn’t indicate billing two units is correct.