Pathology/Lab Coding Alert

Question: We are a pathology group that is contracted with the hospital to perform all pathology services. Sometimes we get a thorocentesis/paracentesis specimen that was sent to hematology for evaluation. Depending on what they find, they will ask our pathologist to review the pre-made slide from their cytospin. We will also receive the fluid, from the same procedure, in which we perform our own cytospin and cell block. Can we bill the professional component on the hematology cytospin slide and if so what code should we be using? Or is this considered a courtesy?

Iowa Subscriber

Answer: Without understanding the relationship between the hematology and pathology groups, it’s difficult to answer your question.

Same entity: Assuming that the hematology and pathology groups are part of the same billing entity, such as the same hospital, the hospital can bill only one unit of the cytospin (88108, Cytopathology, concentration technique, smears and interpretation [e.g., Saccomanno technique]) for a single thorocentesis/paracentesis specimen. If hematology bills 88108 globally, pathology should not additionally bill 88108 or 88108-26 (Professional component). Nor should pathology bill a consultation for reviewing the hematology slide, because a consultation occurs only between different billing entities.

However, the pathology department can bill for the cell block, if performed (88305, Level IV - Surgical pathology, gross and microscopic examination, Cell block, any source.)

Different entity: Assuming the hematology and pathology groups are not part of the same billing entity, you have a different answer to your question. Further, the answer varies depending on whether pathology receives the thorocentesis/paracentesis specimen directly from the performing physician, or if pathology receives the fluid along with a prepared slide from hematology.

If pathology receives the cytology specimen directly from the ordering physician and performs a cytospin and cell block evaluation, you should bill 88108 and 88305. If pathology also receives prepared cytospin slide(s) from the same case from a hematologist (different billing entity) with a request for consultation (slide review), you should also report 88321 (Consultation and report on referred slides prepared elsewhere).

On the other hand, if pathology receives thorocentesis/paracentesis prepared cytospin slides and fluid from hematology (different billing entity) with a request for review (consultation), you’ll bill differently. In that case, if pathology reviews the prepared slide(s), and also performs cytospin and prepares and evaluates slides, you should bill 88323 (Consultation and report on referred material requiring preparation of slides).