Pathology/Lab Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: When our pathologists examine a surgical case, they often review old cytology slides from the patient. The pathologists call the service "cyto-histo correlation," which they perform to ensure that no diagnostic discrepancies exist. Can we bill for the cytology review as a consultation, or is it considered quality assurance, which we can't bill for? Massachusetts Subscriber


Answer: The Clinical Laboratory Improvement Amendment (CLIA) requires cyto-histo correlation between all malignant or premalignant gynecological cytology findings and subsequent histopathology. The correlation is the standard of care, and labs generally document the process as a part of their quality assurance program. As such, you should not routinely bill for the cyto-histo correlation. You can code separately for the service in some circumstances, however, as reported in June 2000 CAP Today. When a discrepancy exists in cytopathology and histopathology findings and the treating physician requests a consultation from the pathologist to further interpret the incongruity and suggest a clinical course of action, you can report a consultation service.

Report 80500 (Clinical pathology consultation; limited, without review of patient's history and medical records) for a requested cyto-histo consultation on slides from the same institution. If another institution submits slides to the pathologist for the requested review, report CPT 88321 (Consultation and report on referred slides prepared elsewhere). To report either of these codes for a cyto-histo correlation, you must meet all four consultation requirements according to section 15020 of the Medicare Carriers Manual:
1) the attending physician must request the consultation (Medicare stipulates that standing orders do not suffice for the request)
2) the consultation must relate to abnormal findings
3) the pathologist must exercise medical judgment
4) the pathologist must submit a written report.