Pathology/Lab Coding Alert

Question: We have a case in which the pathologist performed touch preps on three separate sentinel lymph nodes during surgery. Should we code this as 88333 and 88334 x 2?

Answer: CPT provides two codes for reporting intraoperative touch preps:

- 88333 --" Pathology consultation during surgery; cytologic examination (e.g., touch prep, squash prep), initial site

- 88334 --" cytologic examination (e.g., touch prep, squash prep), each additional site.

Correct coding: You should bill the three touch preps as 88333 x 3, indicating that the pathologist performed an intraoperative touch prep consultation on three distinct specimens.

Here's why: The two codes refer to the -site- of the touch prep. The multiple -sites- identified by the codes refer to the pathologist -touching- a slide to different locations on a single specimen.

Do this: You should use 88333 and 88334 together when the pathologist takes multiple touch preps from a single specimen. CPT defines a specimen as -tissue or tissues that are submitted for individual and separate attention, requiring individual examination and pathologic diagnosis.-

Your case: In the example you gave, the pathologist has three separate specimens --" three individual sentinel lymph node biopsies that the pathologist later examines and bills as three units of 88307 (Level V -- Surgical pathology, gross and microscopic examination; sentinel lymph node).

Because the pathologist does not examine three touch-prep sites from a single specimen, you should not bill the case as 88333 and 88334 x 2. Report 88333x3 instead.

Don't try to fool Medicare: You can't simply substitute a less-specific pathology consultation code, such as 80500 (Clinical pathology consultation; limited, without review of patient's history and medical records) for 85060.

Other payers are different: Some payers, such as your local Medicaid and some private insurers, may not have the same coverage rules as Medicare concerning 85060. You should contact your payers to ensure that you-re coding the interpretation in accordance with payer rules.