Pathology/Lab Coding Alert

Question: We have three scenarios involving pathology consults on previously diagnosed material referred from elsewhere:

1.Pathologist receives neck dissection case with several slides from site A - left neck lateral and several slides from site B - left neck medial

2.Pathologist receives neck dissection case with two blocks labeled left neck A and left neck B

3.Pathologist receives left neck dissection block from one lab, and left cervical sentinel lymph node slides from a separate lab for consultation.

Can you tell us how to code each of these?

Answer: The correct coding for the three outside pathology consultation scenarios are as follows:

1.You should bill the first example as 88321 (Consultation and report on referred slides prepared elsewhere), because you receive prepared slides

2.Code the second case as 88323 (Consultation and report on referred material requiring preparation of slides), because you receive blocks of tissue and prepare your own slides

3.Your last example involves two separate cases. You receive a block from one lab and a sentinel lymph node from a different lab. You should bill 88323 for the left neck dissection block and 88321 for the sentinel lymph node slides.

Unit rules: Unlike surgical pathology codes, the unit of service for 88321-88325 is not the specimen — it is the “case” or “accession.” A case might include multiple specimens from the same surgical session. For non-Medicare payers, you might bill multiple units of 88321 or 88323 if the referral involves two accessions from two separate operative sessions or dates of service.

Caveat: You should bill only one unit of service for 88321-88325 if Medicare is the payer, even if you review multiple cases from the same patient on the same date. That’s because “CMS payment policy allows only one unit of service for CPT^® codes 88321, 88323, and 88325 per beneficiary per provider on a single date of service,” according to the CCI Policy Manual.

Don’t forget 88325: You should be aware that CPT^® provides a third consultation code choice if the pathologist performs a comprehensive review: 88325 (Consultation, comprehensive, with review of records and specimens, with report on referred material).