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Pathology/Lab Coding Alert

You Be the Coder:

Forget 'Pass' for FNA

Published on Mon Oct 10, 2011

Question: Our pathologist performed an adequacy check for two transbronchial FNA passes and identified the second pass as adequate for evaluation. The pathologist then performed the definitive FNA diagnosis for the specimen. How should we code?

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Answer: The correct codes for fine needle aspiration (FNA) adequacy checks are 88172 (Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, first evaluation episode, each site) and +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]). The code for the FNA diagnosis is 88173 (... interpretation and report).

Because the "pass" is no longer the unit of service for FNA adequacy check, the answer to your question depends on some details that you don't provide. Specifically, you need to know the "evaluation episode," not the "pass" to determine proper coding for this scenario.

Definition distinction: A "pass" describes a single aspirate withdrawal (surgical procedure) from a site. An "evaluation episode" describes the pathologist's adequacy check for one or more passes. So a pass and an evaluation episode are synonymous if the pathologist evaluates one FNA pass and reports back to the surgeon before any further action. On the other hand, pass and evaluation episode are different if the surgeon sends multiple passes to the lab and the pathologist examines them all at once to ensure an adequate specimen.

Because your question only mentions pass, not evaluation episode, two answers are possible:

  • The surgeon sends both FNA passes to the pathologist at one time, which the pathologist determines provides adequate material for diagnosis. The pathologist performs the interpretation and report. Code this scenario as 88172 and 88173.
  • The surgeon sends one pass to the pathologist, which he reports to the surgeon as inadequate for diagnosis. The surgeon sends a second pass to the pathologist, which he reports is adequate for diagnosis. The pathologist performs the interpretation and report. Code this scenario as 88172, +88177, and 88173.

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