Pathology/Lab Coding Alert

Answer: The appropriate code for cerebrospinal fluid cytology exam depends on the methods used. For direct smears, you should report 88104 (Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation). If your lab uses the common thin-layer preparation technique, however, report 88108 (Cytopathology, concentration technique, smears and interpretation [e.g., Saccomanno technique]). Although this code specifically names Saccomanno technique, it is just an example, and the code is also appropriate for any other concentration technique such as cytospin or thin prep.

If you evaluate both direct and concentrated smears, report both 88104 and 88108. Beware that you cannot bill both codes to Medicare without a modifier because of a Correct Coding Initiative (CCI) edit. When you perform both services on the same day due to medical necessity, report the code with modifier -59 (Distinct procedural service) to indicate that you performed two separate cytology procedures.

Regarding the stains, the smear preparation and evaluation service includes the three mentioned because they are routine stains. If you perform other stains that are not routine, such as acid fast or trichrome, report the appropriate code 88312-88314 (Special stains [list separately in addition to code for surgical pathology examination] ...) in addition to the cytology exam code.

Some labs have reported that certain payers deny the special stain codes 88312-88314 when reported with any service other than one of the surgical pathology Code 88302-88309. The special stains are "add-on" codes, meaning that you must report them in addition to the primary service. Their use, however, is not restricted to a specific range of codes as long as you report them with a "primary procedure," such as smear interpretation 88104, according to CPT instruction.