Pathology/Lab Coding Alert

New codes 88333 and 88334 will help you overcome an NCCI roadblock

You've had to eat the $36 that Medicare won't pay for 88161 with 88331 since the National Correct Coding Initiative (NCCI) edits bundled the pair in January 2004. Now you can get paid for both an intraoperative frozen section and touch prep--but you won't use 88161 to do it
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Beginning Jan. 1, 2006, you should use new CPT 88333 (Pathology consultation during surgery; cytologic examination [e.g., touch prep, squash prep], initial site) and 88334 (... cytologic examination [e.g., touch prep, squash prep], each additional site) to report intraoperative pathology consultations that use touch preps, which involve crushing or touching excised tissue to a slide to remove cells for tumor evaluation.

Location Distinguishes Codes

You'll use new codes 88333 and 88334 only for touch preps that the pathologist performs in the surgical theater as part of a consultation with the surgeon. These codes do not replace 88161 (Cytopathology, smears, any other source; preparation, screening and interpretation). CPT 2006 includes a text note that states, "Do not report 88333 and 88334 for non-intraoperative cytologic examination, see 88160-88162."

Don't miss: "You should continue to use cytology codes for smears that are not part of a surgical consultation," says Ernest J. Conforti, MSHS, SCT (ASCP) MT, assistant director of anatomic pathology operations at North Shore-Long Island Jewish Health System, headquartered in Great Neck, N.Y. Those codes include 88160 (Cytopathology, smears, any other source; screening and interpretation), 88161 and 88162 (... extended study involving over 5 slides and/or multiple stains).

88333 Includes 88329 Service

You used to report two codes when a pathologist performed a touch prep during an intraoperative consultation. But now you'll just use one new code because 88333 describes both services.

For example: The surgeon calls the pathologist to the operating room to consult on a lung biopsy. The pathologist performs a touch prep on the specimen and reports the findings and diagnosis to the surgeon during the procedure.

Old way: In 2005, you would report each service separately: 88329 for the consultation during surgery and 88161 for the touch prep.

New way: In 2006, you need only one code to report the service: 88333. "Don't report 88329 and 88333 together for an intraoperative consultation that includes a touch prep," Conforti says.

Use 88333-88334 Together--Like 88331-88332

If the pathologist looks at touch preps from multiple sites during a surgical consultation, you need to use both 88333 and 88334. List 88333 for the initial touch prep and one unit of 88334 for each touch prep from additional sites. In other words, apply these codes in a fashion similar to frozen section codes, in which you use 88331 (Pathology consultation during surgery; first tissue block, and frozen section[s], single specimen) for the first block and one unit of 88332 (... each additional tissue block with frozen section[s]) for each additional block from the same specimen.

For instance: The surgeon calls in the pathologist to consult on surgical margins of a breast excision. The pathologist performs touch preps on four margins individually identified by orientation. "You should report the consult and touch preps as 88333 and 88334 x 3," Conforti says.

Report Frozens Plus Touch Preps Together Again

Sometimes a pathologist performs multiple diagnostic procedures as part of the intraoperative consultation. "Using both touch preps and frozen sections during a surgical consultation is not unusual," says Stephen Yurco III, MD, partner and pathologist at Clinical Pathology Associates in Austin, Texas. But the NCCI edit that bundles 88331 and 88161 meant that you could not get paid for both services during a consultation on a single specimen.

Opportunity: Codes 88333 and 88334 change all that. "The new CPT codes for intraoperative cytologic examination should allow us to get paid for touch preps during surgery, whether we perform the cytology alone or in conjunction with frozens," Yurco says.

A new CPT text note confirms that billing for cytology and frozens together may be appropriate. How to do it: "For intraoperative consultation on a specimen requiring both frozen section and cytologic evaluation, use 88331 and 88334." Notice that you should report the touch prep using 88334, not 88333, presumably because the touch prep comes from an "additional site" distinct from the frozen section.

Treat Needle Biopsy and Fine Needle Aspiration Differently

What if the pathologist evaluates a fine needle aspiration (FNA) during surgery? You should continue to use 88172 (Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen[s]) and 88173 (... interpretation and report) for FNA evaluation, regardless of where or when the pathologist performs the service.

If the pathologist checks an FNA specimen for adequacy during surgery, you should still use code 88172, not 88333.

Don't overlook: Just to make sure you're not confused about the new codes' relationship to FNA cytology evaluation, CPT added this note under 88334: "Do not report 88333 and 88334 for intraprocedural cytologic evaluation of fine needle aspirate, see 88172."

On the other hand: If a needle biopsy requires cytology evaluation during surgery, that's another matter. CPT states, "For percutaneous needle biopsy requiring intraprocedural cytologic examination, use 88333."
For example, if the surgeon extracts a punch biopsy from a large skin lesion and the pathologist examines a touch prep prepared from the specimen, the proper code for the pathologist's work is 88333.