3 Tips Keep Your Endocervical Coding on the Up and Up
Published on Mon Nov 26, 2007
Don't use Pap codes for endocervical -brushing biopsy-
Following an abnormal Pap, your pathologist receives an endocervical specimen for diagnosis--biopsy, curettage or brushing. How should you code it? Let our experts show you how to choose the right codes when you follow these guidelines: Tip 1: Use Surgical Pathology Codes for Endocervical Tissue When the surgeon submits an endocervical biopsy or curettage, you should list your pathologist's work as 88305 (Level IV--Surgical pathology, gross and microscopic examination; endocervix, curettings/biopsy). Although curettage, which involves scraping, is a different procedure than biopsy, which involves cutting tissue, CPT lists both biopsy and curettage specimens as 88305.
Don't miss: The pathology report might use terms such as -endocervical scrapings- or -ECC- for endocervical curettage specimens. Regardless of the name, you should code the pathologist's exam of an endocervical tissue sampling as 88305, says R.M. Stainton Jr., MD, president of Doctors- Anatomic Pathology Services in Jonesboro, Ark.
Tip 2: Use Cytology Codes for Endocervical Brushings What if the surgeon takes an endocervical -brushing- in addition to or in place of an ECC or biopsy specimen to diagnose a patient following an abnormal Pap?
Do: Assuming the lab processes the sample as a smear, such as a Papanicolaou stain, you should bill an endocervical brushing using a cytopathology code from the 88104-88112 series. You should not use the surgical pathology code (88305) because the specimen is cellular (cytology) rather than tissue (histology), says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc., a pathology business practices company in Simpsonville, Ky., publisher of Pathology Service Coding Handbook. Although you may see an endocervical brushing called a -brushing biopsy,- it is not an 88305 tissue biopsy.
Don-t: Because the pathologist is not -screening- for abnormal cells in an endocervical brushing, you shouldn't use Pap codes such as 88142 (Cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision), according to Padget. This advice accords with guidance given in the July 2006 CAP Today concerning endocervical brushings taken with cervical biopsies.
Do this: Select the proper non-gynecological cytopathology code, based on method, to report endocervical brushings taken by a surgeon for diagnostic pathology exam. For instance, if the lab uses a cell enhancement/concentration thin-layer preparation for the slides, you should report the service as 88112 (Cytopathology, selective cellular enhancement technique with interpretation [e.g., liquid based slide preparation method], except cervical or vaginal).
Watch for: Labs sometimes process endocervical brushing specimens as a cell block alone, without a smear preparation. In that case, report 88305 (Level IV--Surgical pathology, gross and microscopic examination; cell block, any source) for the specimen exam. If the pathologist also examines an endocervical biopsy and/or ECC in addition to the cell block, [...]
