Pathology/Lab Coding Alert

Question: When we receive a BAL specimen, what code should we use when we perform a cell count (including differential count) and examine a smear following cytospin?


Colorado Subscriber


Answer: Processing a bronchoalveolar lavage (BAL) specimen as you described requires two codes. Report 88108 (Cytopathology, concentration technique, smears and interpretation [e.g., Saccomanno technique]) for the cytologic evaluation of non-gynecological smears processed with a concentration technique such as cytospin. Common sources for this service include fluids, washings and brushings such as BAL, cerebrospinal fluid, or peritoneal washings. This service involves concentrating the cytology specimen and preparing slides and stains to test for malignant cells.

If the physician orders a white count and differential on the same fluid, you should also report 89051 (Cell count, miscellaneous body fluids [e.g., CSF, joint fluid], except blood). For example, if the BAL appears to indicate an infectious pathology rather than a tumor, the physician might want to get an idea of the presence and types of white cells. Note that the differential count would not be quantitative because of the dilution of the washing.

Although 89051 is more commonly used for body fluids such as cerebrospinal fluid, a physician might order the cell count for a BAL in some circumstances. The key is to report both the cytologic evaluation and the differential count if the lab provides both services.