Pathology/Lab Coding Alert

Question: When our pathologist processes a lymph node specimen, he often prepares touch prep slides for H&E staining that he examines along with the tissue slides. Can we charge for the touch preps in addition to the lymph node specimen exam?

Tennessee Subscriber

Answer: No, you shouldn't charge for tissue touch preps in addition to the tissue specimen exam for the situation you described. You should bill only 88305 (Level IV -- Surgical pathology, gross and microscopic examination, lymph node, biopsy).

CPT provides the following codes for touch preps:

• 88161 -- Cytopathology, smears, any other source; preparation, screening and interpretation
• 88162 -- ... extended study involving over 5 slides and/or multiple stains
• 88333 -- Pathology consultation during surgery; cytologic examination (e.g., touch prep, squash prep), initial site
• 88334 -- ... cytologic examination (e.g., touch prep, squash prep), each additional site (List separately in addition to code for primary procedure).

You should not use codes 88333-88334 for the touch preps in the case you describe, because the pathologist does not perform the service as part of a consultation during surgery. To use 88333-88334, the pathologist must examine the touch preps and report the results to the surgeon while the patient is still "on the table."

Although you can use 88161 (or 88162 for more than five slides and/or multiple stains) to describe touch preps, bundling issues prohibit you from using the codes in this case.

Here's why: Medicare's Correct Coding Initiative (CCI) bundles 88161 and 88162 as column 2 (component) codes with 88305. Because the touch prep and the tissue exam involve the same specimen, you should not override the edit pair using modifier 59 (Distinct procedural service). In other words, 88305 includes the steps that your pathologist takes to examine the specimen to reach a diagnosis, including touch preps and tissue sections.