Pathology/Lab Coding Alert

Question: I've heard that we can't bill any additional preparations with an FNA specimen. Does that mean we can't bill 88305 for a cell block with 88173 for the FNA?

Michigan Subscriber

Answer: No -- the restriction on "additional preparations" with a fine needle aspirate (FNA) specimen doesn't extend to a cell block. If the pathologist evaluates an FNA specimen and a cell block prepared from aspirate remaining following smear preparation, you can report both of the following codes:

• 88173 -- Cytopathology, evaluation of fine needle aspirate; interpretation and report

• 88305 -- Level IV -- Surgical pathology, gross and microscopic examination, cell block, any source.

The restriction for additional preparations that you refer to involves other non-gyn cytopathology codes 88104-88112 (Cytopathology, fluids, washings or brushings, except cervical or vaginal; ...) and 88160-88162 (Cytopathology, smears, any other source; ...).

You shouldn't report any of these codes in addition to 88173 for a single FNA specimen for two reasons:

1. An FNA specimen is a source distinct from "fluids, washings, or brushings" (88104-88107), concentrated or liquid-based smears (88108-88112), and "any other source" (88160-88162). Only 88172 and 88173 describe the FNA specimen type.

2. Medicare considers a second preparation on a specimen to be a duplicate service, except when the second preparation is a tissue cell block. Even if the pathologist examines concentrated smears, you can't bill an additional cytopathology code such as 88108 (Cytopathology, concentration technique, smears and interpretation [e.g. Saccomanno technique]) for the concentration step.

Bottom line: Code 88173 includes interpretation of all cytology slides examined from the aspirate regardless of slide preparation method. If the pathologist prepares a cell block, however, you can additionally report the pathology exam of those slides using 88305.