Pathology/Lab Coding Alert

Surgical procedure influences pathology exam code

How will you know if your pathologist examined cells removed from a cyst, cells aspirated from a solid tumor, or a needle-core tumor specimen? With Medicare's payment for a needle-specimen pathology exam ranging from $50 to $163, you need to get the specimen right.

Knowing how the surgeon removed the specimen can help you get it right. "The surgical procedure code can provide information you need to determine the pathology specimen," says Laurie Castillo, MA, CPC, CPC-H, CCS-P, owner of Castillo Consulting in Manassas, Va.

Recognize Needle Specimens -- and Needle Procedures

Look at the following table for some common examples of needle-specimen exams and their Medicare national payment rates. You can see that whether you report a breast aspiration as an FNA exam (CPT 88173 ) or a direct-smear cytopathology exam (88104) can make a big difference to your pathologist's bottom line. 

Breast Example: Physicians may want to sample breast cells using various needle-extraction methods, either to diagnose a patient or to treat a condition such as a breast cyst. "For diagnosing a suspicious breast lesion, the physician may perform an FNA using a thin needle to extract a small sample of cells, or a larger needle to remove a core-biopsy of breast tissue," Castillo says.

To drain a breast cyst that has become large and painful, the physician may use a needle to extract the breast-cyst contents. Familiarize yourself with the surgical codes for each of these procedures: