Pathology/Lab Coding Alert

Question: Our pathologists always review patient records when they examine a bone-marrow or fine-needle aspiration. Is this review sufficient to bill 80502 with the aspiration?


Georgia Subscriber


Answer: No, you cannot automatically bill 80502 (Clinical pathology consultation; comprehensive, for a complex diagnostic problem, with review of patient's history and medical records) with each aspiration exam, even if the pathologist reviews patient records.

For either 80502 or 80500 (Clinical pathology consultation; limited, without review of patient's history and medical records), the attending physician must request a consultation, and standing orders do not satisfy that requirement. Also, you can only perform an 80500 or 80502 clinical pathology consultation on a test result that lies outside the clinically significant expected range, results in a written report, and involves the exercise of medical judgment, according to CMS. 

About the only time you would report 80500 or 80502 with an FNA or bone-marrow aspiration would be when the physician requests a cyto-histo correlation for specimens from your institution. For instance, if the results of a breast FNA and a subsequent breast biopsy show a discrepancy, the physician may ask the pathologist to further interpret the incongruity and suggest a clinical course of action.

You should report 80500 or 80502 only when the consultation request is for slides from within your institution. If one or both sets of slides are from an outside institution, you should instead submit 88321 (Consultation and report on referred slides prepared elsewhere). If your lab receives referred material and prepares slides for interpretation, you should report 88323 (Consultation and report on referred material requiring preparation of slides). Relative to your question regarding records review, if the pathologist must also review records related to the referred-specimen exam, you should report 88325 (Consultation, comprehensive, with review of records and specimens, with report on referred material).

Lesson learned: You cannot use any of the consultation codes (80500, 80502 or 88321-88325) unless the pathologist has a request from the treating physician, exercises medical judgment regarding an unexpected result, and files a written report of findings.