Pathology/Lab Coding Alert

Question: Are certain stains that are commonly used in the preparation of bone-marrow smears for interpretation considered bundled in the service described by 85097? Other than immunoperoxidase, which stains are not considered bundled in the 85097 service and could therefore be reported separately?

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 Answer: Smears are usually prepared from bone-marrow aspirates using a Wright stain or Wright/Giemsa stain. Because this stain is standard protocol for the preparation of bone-marrow aspirate smears, it is considered included in the evaluation service (85097, bone marrow; smear interpretation only, with or without differential cell count) and is not separately reportable. This is akin to the situation with anatomic pathology specimens, where H&E (hematoxylin and eosin) is the standard stain for tissue preparation and is not separately coded.
 
As with tissue, bone-marrow aspirate may be processed with different stains that are separately reportable. For example, bone-marrow aspirates may be subjected to an iron stain (88313, special stains [list separately in addition to code for surgical pathology examination]; group II, all other [e.g., iron, trichrome] except immunocytochemistry and immunoperoxidase stains, each) used in the diagnosis of iron deficiency anemia. Or the pathologist may use a periodic acid shift stain (88312 group I for microorganisms [e.g., Gridley, acid fast, methenamine silver], each) when evaluating certain types of leukemia. These services should be reported in addition to the bone-marrow aspiration (85095) as well as the interpretation of the aspirate (85097).

 
-- Answers to You Be the Coder and Reader Questions provided by Laurie A. Castillo, MA, CPC, CPC-H, CCS-P, president of Physician Coding & Compliance Consulting in Manassas, Va.; Elizabeth Sheppard, HT (ASCP), manager, anatomic pathology, Wake Forest University Baptist Medical Center, N.C.; and R.M. Stainton Jr., MD, president of Doctors Anatomic Pathology Services in Jonesboro, Ark.