Pathology/Lab Coding Alert

Question: We have a pathology report for a bone osteoma exam that includes mention of decalcification, H&E and Toluidine Blue O stains. How should we code this?

Tennessee Subscriber

Answer: The correct code for the bone osteoma pathology exam is 88305 (Level IV - Surgical pathology, gross and microscopic examination… Bone exostosis…). You should not apply a second code for the hematoxylin and eosin (H&E) stain, because that is the basic stain for most pathology specimens.

On the other hand, you should separately charge for the Toluidine Blue O special stain and for the decalcification procedure. The decal procedure is common for bony specimens, but does earn a separate code of +88311 (Decalcification procedure (List separately in addition to code for surgical pathology examination)).

For the Toluidine Blue O, report code 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).

Units: You don’t describe how the specimen is processed, but if the lab prepares multiple blocks and performs the special stain on slides from each block, you should bill multiple units of 88313. CPT^® provides a text note under the code that states, “Report one unit of 88313 for each special stain, on each surgical pathology block, cytologic specimen, or hematologic smear.”.