Pathology/Lab Coding Alert

Check out +88334 restrictions.

Serious pitfalls greet you on the road to coding your pathologist's consults during surgery. With a few myths in mind, you might be coding "conservatively" - and costing your pathologist much-deserved pay.

Read on for myth-busting tips to let you code intraoperative pathology consults with confidence, and gain the rewards of clean claims and rejuvenated revenue.

Remember: You can use the intraoperative pathology consultation codes only when the pathologist examines the tissue and reports the findings to the surgeon who requested the consult while the patient is still in the operating theatre.

Myth 1: The Unit of Service is 'Specimen'

Unlike most pathology services, the unit of service for pathology consultation during surgery is not the specimen.

Baseline: Other than a gross-only consult (88329, Pathology consultation during surgery) pathologists typically examine tissue during surgery using either frozen sections, which report to these codes:

• 88331 (Pathology consultation during surgery; first tissue block, with frozen section(s), single specimen)
• +88332 (... each additional tissue block with frozen section(s) (List separately in addition to code for primary procedure))

or touch preps, which report to these codes:

• 88333 (... cytologic examination (eg, touch prep, squash prep), initial site)
• +88334 (... cytologic examination (eg, touch prep, squash prep), each additional site (List separately in addition to code for primary procedure)).

The definitions hold the key to the unit of service for these codes. You can see that "tissue block" from a single specimen is the unit of service for 88331-+88332. On the other hand, "site" from a single specimen is the unit of service for 88333-+88334.

Frozen section examples: If the pathologist examines frozen sections from two blocks of a partial mastectomy specimen, you should code 88331 and +88332. But if the pathologist examines frozen sections from one block of the partial mastectomy, plus frozen sections from a lymph node biopsy, you should code 88331 x 2.

Touch-prep examples: If the pathologist examines touch preps from two distinct margins of a partial mastectomy specimen, you should code 88333 plus +88334. But if the pathologist examines touch preps from just one site of the partial mastectomy, plus touch preps from one site of a lymph node biopsy, you should code 88333 x 2.

Myth 2: You Can't Report Both Frozen Sections and Touch Preps

Some coders believe you should never code pathology consultations for both touch preps and frozen sections in the same surgical session - but that's wrong.

"A pathologist might perform both services while the patient is still in surgery, such as evaluating a single block using frozen sections from the primary tumor, and evaluating multiple touch preps from different surgical margin sites," says R.M. Stainton Jr., MD, president of Doctors Anatomic Pathology Services in Jonesboro, Ark.

Do this: CPT^® provides instruction for cases like this: "For intraoperative consultation on a specimen requiring both frozen section and cytologic evaluation, use 88331 and +88334."

Pitfall: Despite the CPT^® instruction about these codes, CMS's Correct Coding Initiative (CCI) bundles 88331 and +88334 as a column 1/column 2 edit pair, meaning that you should not report the two codes together. However, CCI lists the edit pair with a modifier indicator of "1," which means you can override the edit pair under appropriate circumstances.

Work around: Remember your units of service - it is not the specimen for frozen sections or touch preps, rather, it is the block or the site. To justify separate 88331 and +88334 charges for a single specimen, you must document that the work was for different blocks or sites from the specimen. The pathology report must uniquely identify the site subjected to frozen sections, and uniquely identify each site used for touch prep(s).

Don't forget: Once you ensure that you have adequate documentation, you'll have to append modifier 59 (Distinct procedural services) or similar modifier such as one of the X{EPSU} modifiers to +88334 to override the CCI edit pair.

Example: Consulting with the surgeon during a mastectomy procedure, the pathologist examines a frozen section block from the breast tissue, and performs one touch prep on a lymph node that the surgeon removed as part of the of the mastectomy. You should code this case as 88331 and +88334-59.

Myth 3: Code +88334 Only Adds to 88333

You can see from the preceding example that this myth is not true. But because 88333 refers to "initial site" and +88334 refers to "each additional site," some coders believe that you can use the add-on code +88334 only with 88333.

In fact: A CPT^® text note following +88334 states, "use +88334 in conjunction with 88331, 88333." In other words, the add-on code +88334 describes an intraoperative touch prep on a site that the pathologist examines in addition to an initial frozen section block, or in addition to an initial touch prep at a different site.