Pathology/Lab Coding Alert

Question: We are having trouble with BCBS of South Carolina about using CPT codes 88170 and 88173 together. The pathologist does the aspiration (88170) and also does the interpretation (88173), but BCBS states these codes cant be used together. Ive sent copies of the reports, and they are still denying our charges. What suggestions can you give me? Also, a decalcification is done on all bone marrows by our pathologist. Does the decalcification have to be in the report before I can charge it?

Karon Strickland
Carolina Pathology Associates, Greenwood, S.C.

Answer: You are correct, 88170 and CPT 88173 are two separate billable procedures. According to guidance provided by the American Medical Association, each code may be billed separately. Billing is this manner is not prohibited under the National Correct Coding Initiative, a tool used by the Health Care Financing Administration to identify and define unbundling. Occasionally, payers will establish aggressive edits and, if unchallenged by the provider, will succeed in reducing their expense. You should request that the payer provide rationale and an explanation as to why a percutaneous biopsy is separately payable while the FNA (fine needle aspiration) is not.

As to the second question: The answer is yes. Documentation is key to appropriate reimbursement. This documentation is easily accomplished by noting in the narrative report that it was performed.