Pathology/Lab Coding Alert

Question: We’ve always reported a trichrome stain on a fecal smear for ova and parasites using 88313, but lately we’ve been getting denials--why?


Minnesota Subscriber


Answer: The correct code for a direct fecal smear for ova and parasites is 87177 (Ova and parasites, direct smears, concentration and identification). In the past, if you also carried out a trichrome stain, CPT instructed you to consult special stain codes in the surgical pathology section. But CPT added a new code to the microbiology section in 2006 that changes all that.

Old way: In addition to 87177, a CPT text note directed coders to +88313 (Special stains [list separately in addition to code for primary service]; Group II, all other [e.g., iron, trichrome], except immunocytochemistry and immunoperoxidase stains, each).

Using this code to report a direct fecal smear stain for ova and parasites caused two problems:

1. Although 88313 lists trichrome as an example, trichrome for ova and parasites is actually a microorganism stain, which you should report with +88312 (Special stains [list separately in addition to code for primary service]; Group I for microorganisms [e.g., Gridley, acid fast, methenamine silver], each). In fact, the same CPT note cross-referenced code 88312 instead of 88313 until the 2002 CPT revision.

2. CPT lists surgical pathology codes 88312 and 88313 as add-on codes for a “primary service.” Pathologists often had a difficult time getting paid for the trichrome stain for ova and parasites because they usually didn’t look at the direct smear--meaning that they did not report a primary service.
 
New way: Now you should report new microbiology code 87209 (Smear, primary source with interpretation; complex special stain [e.g. trichrome, iron hematoxylin] for ova and parasites) in addition to 87177. CPT has replaced two old text notes following 87177 and 87207 directing coders to 88312 and 88313 with a new note following 87177 directing you to 87209.