Pathology/Lab Coding Alert

Question: We received a denial for a case in which the pathologist interpreted FNA specimens from the right thyroid gland and the thyroid isthmus. The pathologist also evaluated two cell blocks from the right thyroid FNA specimen. Did we correctly code the case as 88173 x 2 and 88305 x 2?

California Subscriber

Answer: You were correct to code two units of the fine needle aspiration (FNA) evaluation as 88173 (Cytopathology, evaluation of fine needle aspirate; interpretation and report). However, this case earns only one unit of the cell-block evaluation code, 88305 (Level IV - Surgical pathology, gross and microscopic examination … cell block, any source …)).

Units: CPT^® states that you should “report one unit of 88173 for the interpretation and report of each anatomic site.” In this case, the pathologist examines an FNA specimen from two distinct anatomic sites: the right thyroid lobe and the thyroid isthmus.

On the other hand, the units of service for anatomic pathology codes, such as 88305, is “the specimen.” The specimen, in this case, is the right thyroid nodule FNA.

CPT^® Assistant, Volume 15, Number 7, clarified this question by stating, “Just as the number of blocks is irrelevant to the units of service for any specimen, the unit of service (… 88305) for a single … fluid specimen is not multiplied irrespective of the number of cell blocks prepared.”