Pathology/Lab Coding Alert

CPT 2004 can help Problem solved. Thanks to CPT Codes 2004 code revisions, labs should no longer get denials for special stain procedures reported with cytopathology or other primary services.
 
Because the old definition for add-on codes 88312 through 88314 included the direction "List separately in addition to code for surgical pathology examination," some payers denied payment for staining services reported with cytopathology or any other procedure besides surgical pathology 88302-88309 (... Surgical pathology, gross and microscopic examination). CPT 2004 Updates Codes to Include Nonsurgical Specimens The CPT 2004 code revisions solve the problem by replacing the words "surgical pathology examination" with "primary service." Although CPT only identifies 88312 as a revised code, the revision applies to the entire code family because the change is in the code's common portion:
 
 +88312 - Special stains (list separately in addition to code for primary service); Group I for microorganisms (e.g., Gridley, acid fast, methenamine silver), each
 
 +88313 - ... Group II, all other (e.g., iron, trichrome), except immunocytochemistry and immunoperoxidase stains, each
 
 +88314 - ... histochemical staining with frozen section(s).   "Despite the change, coders should remember that codes 88312-88314 still represent each stain performed, not each slide stained," says Elizabeth Sheppard, HT (ASCP), manager of anatomic pathology at Wake Forest University Baptist Medical Center in Winston Salem, N.C. Report Separate Stains With Microbiology Microbiology services sometimes incorporate special stains that CPT lists in the surgical pathology section. For example, the lab may perform a trichrome stain for ova and parasites on a stool sample direct smear. Report the primary service as 87177 (Ova and parasites, direct smears, concentration and identification) and the trichrome stain as 88313. A note following 87177 in the CPT manual directs coders to the appropriate stain code - "For trichrome, iron hemotoxylin and other special stains, use 88313." A similar directional note following 87207 instructs coders, "For complex special stains, see 88312, 88313."
 
Despite the fact that earlier CPT versions directed coders from the microbiology section to the special stain codes in the surgical pathology section, some labs reported denials. "Changing the definitions of 88312-88314 to 'primary service' instead of 'surgical pathology examination' should clarify to payers that labs can use these special stain codes with procedures outside the surgical pathology section," Sheppard says. Make Sure Lab Certification Is Correct Even a coding clarification for 88312-88314 won't stop the denial problem if improper lab certification is the culprit. Sometimes payers deny stain codes because they're from the surgical pathology section, and the clinical laboratory has certification for microbiology and parasitology, but not for anatomic pathology. Labs can appeal the denial and [...]