Pathology/Lab Coding Alert

Question: Our pathologist was called to the operating room to evaluate a kidney biopsy specimen to ensure that it contained satisfactory levels of glomeruli for diagnosis. The pathologist affirmed the specimen, and the surgeon closed and submitted the biopsy for diagnosis. Our pathologist evaluated the specimen using PAS, trichrome, and methenamine silver stains. How should we code the case?

Minnesota Subscriber

Answer: You didn't mention that the pathologist performed any touch preps or frozen sections during the kidney biopsy adequacy check in the operating room, so you should bill the intraoperative consultation as 88329 (Pathology consultation during surgery).

The correct code for the pathologist's kidney biopsy exam is 88305 (Level IV - Surgical pathology, gross and microscopic examination, ... Kidney, biopsy ...).

Pathologists often use the three special stains you mentioned for kidney biopsies: periodic-acid Schiff (PAS), trichrome, and methenamine silver. These stains allow the pathologist to visualize the distinction between the cytoplasm and the extracellular matrix to aid in diagnosis. Because these stains are not for microorganisms, you should use 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).

According to CPT^® instruction, you should "report one unit of 88313 for each special stain, on each surgical pathology block ..." You don't indicate that the pathologist processed the biopsy in more than one block, so you should report three units of 88313 - one for each special stain.