Pathology/Lab Coding Alert

Question: The pathologist interprets two FNA specimens -- one from a nodule in the right thyroid lobe, and one from the left thyroid lobe. Examining the aspirates involves concentrated smears from both FNA sites, and one cell block from the right lobe and two cell blocks from the left. How should we code the case?Georgia SubscriberAnswer: This case involves multiple procedures, and you should code some of them separately. You must ensure that the pathology report documents each individual service.Because the two FNA specimens are from different sites (left and right thyroid lobe), you should report two units of 88173 (Cytopathology, evaluation of fine needle aspirate; interpretation and report). You should not separately report additional smear preparations, such as concentrated smears, using an additional code, even if that code appropriately describes the work your lab performed -- such as 88108 (Cytopathology, concentration technique, smears and interpretation [e.g., Saccomanno technique]) or 88112 (Cytopathology, [...]