Pathology/Lab Coding Alert

Question: Our pathologist evaluated FNA thyroid specimens from three “passes.” First, he received the fluid from the three passes and performed an intraoperative evaluation for adequacy. Then he used liquid-based cytology for the slides. Should I report 88172 and +88177x2; 88173, and 88112?

Alabama Subscriber

Answer: No, that’s not the correct coding for this case. Instead, you should report 88172 (Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, first evaluation episode, each site) and 88173 (Cytopathology, evaluation of fine needle aspirate; interpretation and report).

Adequacy: The unit of service for fine needle aspiration (FNA) adequacy check is the “site,” not the number of passes. Because you mention just one site (thyroid) and just one “evaluation episode” for three passes from that site, you should use just one unit of 88172 and not use +88177 (… immediate cytohistologic study to determine adequacy for diagnosis, each separate additional evaluation episode, same site (List separately in addition to code for primary procedure)).

Evaluation: You have it right that you should list just one unit of 88173 for the case. But 88173 includes all the work to process and evaluate the cytology specimen, regardless of the lab method used or the number of slides. That means you should not list 88112 (Cytopathology, selective cellular enhancement technique with interpretation (eg, liquid based slide preparation method), except cervical or vaginal) in addition to 88173.

NCCI: In fact, there’s a National Correct Coding Initiative (NCCI) edit that lists 88112 as a column 2 code for 88173. Although an NCCI-associated modifier may override the edit pair, you should not bill both codes for the same specimen.