Pathology/Lab Coding Alert

Question: When our pathologist receives material from another physician for slide preparation and interpretation, should we code only 88323? I received a suggestion to code 88323-26 and 88305-TC and would appreciate clarification.

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Answer: Your question doesn’t make clear whether the pathologist receives material from another physician as a consultation. If the order confirms a request for consultation, and the pathologist prepares and interprets slides and provides a report back to the referring physician, you should code this as 88323 (Consultation and report on referred material requiring preparation of slides).

Rember modifiers: Code 88323 includes the technical work of preparing the slides and the professional service of interpretation. If your lab performs just one part of that service, you could bill 88323 with modifier TC (Technical component…) for the slide prep, or modifier 26 (Professional component) for the interpretation. If the service your pathologist provides includes both components, you should not use one of these modifiers.

Code 88305 (Level IV - Surgical pathology, gross and microscopic examination …) includes the initial gross and microscopic evaluation of a tissue specimen, specifically a type of specimen listed in the code, such as “colon, biopsy.” The situation you describe does not fit the 88305 code descriptor.

And remember this modifier advice: The National Correct Coding Initiative (NCCI) edits lists 88305 as a column 2 code for 88323 but with a modifier indicator of “1,” meaning that you can override the edit with an NCCI-associated modifier when circumstances and documentation support it.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC