Pathology/Lab Coding Alert

Specimens, blocks, smears or stains - just what is the unit of service for pathology procedures ? If you answered "all of the above," you would be correct - but not all of the time. Our experts will show you the proper units for a myriad of different pathology services.
 
"If you don't get the unit of service right, you could cost your practice in uncollected revenues," says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha. Code per Smear Method for Cytopathology Non-gynecological cytopathology codes 88104-88108 may say "smears" in the definitions, but that doesn't mean you'll report only one procedure code for all smears from a single source. "If the lab uses different methods to process and evaluate smears from a single source, such as direct smears, cytospins, and cell block, you should separately report each method," Slagle says.
 
For example, if the lab prepares and interprets a direct smear from a bronchial washing and also spins the remaining sample to concentrate cells for smear preparation and interpretation, you should report two separate cytopathology procedures. The codes are 88104 (Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation) and 88108 (Cytopathology, concentration technique, smears and interpretation [e.g., Saccomanno technique])
 
You cannot bill both codes to Medicare without a modifier because of a National Correct Coding Initiative (NCCI) edit. When you perform both 88108 and 88104 on the same day due to medical necessity, append modifier    -59 (Distinct procedural service) to indicate that you performed two separate cytology procedures. "The pathology report must document that you performed two separate services, stating, for example, that you performed a 'direct smear' and a 'cytospin,' " Slagle says.  Report Each Specimen for Surgical Service You should report surgical pathology codes based on the specimen, regardless of how many containers, blocks or slides the pathologist examines. Codes 88300-88309 represent ascending work levels (Levels I-VI) defined as "surgical pathology, gross and microscopic examination" (except 88300, which is gross examination only). A list of specimens follows each code, and you should assign the code based on the type of specimen.
 
For example, if the surgeon submits a left breast in one container and associated left axillary lymph nodes in another, you should report 88309 (Level VI - surgical pathology, gross and microscopic examination, breast, mastectomy - with regional lymph nodes). "You should code based on the defined specimen, not based on the number of containers," says R.M. Stainton Jr., MD, president of Doctor's Anatomic Pathology, an independent pathology laboratory in Jonesboro, Ark.
 
The number of tissue blocks and [...]