Pathology/Lab Coding Alert

Question: Our pathologist examined an iliac crest bone marrow biopsy following decalcification. The case involved Wright-Giemsa and iron stains, plus flow cytometry for kappa and lambda. How should we code this case?

Texas Subscriber

Answer: The case you describe involves multiple separate procedures, so you need to be careful to list the code for each step of the bone marrow biopsy evaluation.

First, code the pathology exam of a bone marrow biopsy specimen as 88305 (Level IV - Surgical pathology, gross and microscopic examination, … Bone marrow, biopsy…). You mention that the lab decalcified the specimen prior to the pathology exam, which is typical for these cases. You should bill the decalcification as +88311 (Decalcification procedure (List separately in addition to code for surgical pathology examination)).

Special stains: You described a Wright-Geimsa and iron stain. Because Wright-Geimsa is the standard stain for bone marrow specimens, you should not bill separately for that stain. The iron stain is a different matter. You should code the iron stain as 88313 (Special stain including interpretation and report; Group II, all other (eg, iron, trichrome), except stain for microorganisms, stains for enzyme constituents, or immunocytochemistry and immunohistochemistry).

Be aware: CPT^® includes a text note under 88313 describing the unit of service for the code: “Report one unit of 88313 for each special stain, on each surgical pathology block, cytologic specimen, or hematologic smear.” You’ll need to report one unit of 88313 for each block processed from the bone marrow biopsy specimen, which you don’t define in your question.

Flow cytometry: You mention kappa and lambda as two flow cytometry markers evaluated in this case. You should code that work as 88184 (Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker) and +88185 (… each additional marker (List separately in addition to code for first marker)). Don’t forget to capture the pathologist’s interpretation of the flow cytometry by reporting 88187 (Flow cytometry, interpretation; 2 to 8 markers).