Pathology/Lab Coding Alert

Question: Following a positive TB skin test, the physician performs a BAL and sends the specimen to the lab for positive identification of tubercle bacilli. The lab analyst examines direct smears with and without an acid-fast stain, then concentrates and cultures the remaining BAL specimen. How should we code the case?

Georgia Subscriber

Answer: You don’t mention if your lab performs the TB skin test, but if so, the proper code for that service is 86580 (Skin test; tuberculosis, intradermal).

For the work on the bronchoalveolar lavage (BAL), you have several codes to report, as follows:

• 88104 — Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation

• 87206 — Smear, primary source with interpretation; fluorescent and/or acid fast stain for bacteria, fungi, parasites, viruses or cell types

• 87015 — Concentration (any type), for infectious agents

• 87116 — Culture, tubercle or other acid-fast bacilli (e.g., TB, AFB, mycobacteria) any source, with isolation and presumptive identification of isolates.