Pathology/Lab Coding Alert

Learn to maneuver 88329-88334 pitfalls and possibilities Specimens, blocks, sites -- if you don't know the unit of service, you could be leaving money on the table. Ramp up your intraoperative consultation coding with the following advice from our experts: 1. Document Consultation During Surgery All consultations require the 3 R's -- request (from treating physician), render (medical opinion) and report (findings). Although you shouldn't even think about reporting a pathology consultation during surgery if you don't have documentation of the 3 Rs, that's not all you need to know. "The nature of an intraoperative consultation is that the pathologist provides immediate feedback to the surgeon during the surgical procedure," says Melissa Sinclair, CPC, an independent consultant based in Denver. The surgeon will use the pathologist's findings to help determine the appropriate course of action while the patient is still on the operating table. "For instance, a preliminary diagnosis of malignancy at the time of surgery could result in a more extensive resection," Sinclair says. 2. Know the Codes CPT provides five codes to describe intraoperative pathology consultations:
- 88329 -- Pathology consultation during surgery
- 88331 -- - first tissue block, with frozen section(s), single specimen
- 88332 -- - each additional tissue block with frozen section(s)
- 88333 -- - cytologic examination (e.g., touch prep, squash prep), initial site
- 88334 -- - cytologic examination (e.g., touch prep, squash prep), each additional site. If the consultation involves only a gross tissue examination by the pathologist, use 88329. "For instance, we might not do a microscopic exam during surgery for a bowel resection that includes a distinct lesion and enough normal mucosa to diagnose clear margins," says R.M. Stainton, Jr., MD, president of Doctors- Anatomic Pathology Services in Jonesboro, Ark. Red flag: When the pathologist performs a gross and microscopic exam (frozen sections or touch preps) during surgery for a single specimen, you should not list 88329 in addition to the other code(s). CPT convention indicates that the indented codes (88331-88334) include the service described by the parent code (88329). 3. Capture Each Frozen Block When a surgeon requests an immediate tumor evaluation during surgery, the pathologist often examines frozen sections to arrive at a preliminary diagnosis. To code these services correctly, you need to understand the preparation method and the unit of service. The surgeon submits a tissue specimen, which the lab may process by flash freezing into one or multiple blocks -- these are tissue blocks. For each block, the pathologist may examine multiple slides of thin sections cut from the frozen tissue block -- these are frozen sections. Don't miss: The unit of service for 88331 and 88332 is the frozen tissue block, not the specimen [...]