Pathology/Lab Coding Alert

Question: When should we use 85535-85536 as opposed to CPT 88313 for iron stain? We have always reported 88313 for an iron stain on a bone marrow biopsy, and only recently became aware of these other codes. Now Im not certain were reporting the proper code.

Ohio Subscriber
 
 Answer: Code 88313 (special stains [list separately in addition to code for surgical pathology examination]; Group II, all other [e.g., trichrome], except immunocytochemistry and immunoperoxidase stains, each) is the correct code to report an iron stain for a bone marrow biopsy specimen. The stain is used to evaluate iron stores in the bone marrow, especially for the diagnosis of iron deficiency anemia (280.x) and other iron metabolism disorders. This code describes both the technical and professional service and requires a pathologists evaluation of the stain.
 
The iron stain (88313) should be reported in addition to the code for pathology examination of the specimen. For a bone marrow biopsy, the evaluation is reported as 88305 (level IV - surgical pathology, gross and microscopic examination; bone marrow, biopsy). These specimens often require decalcification before staining, which should be reported in addition to the iron stain using 88311 (decalcification procedure). If the specimen is a bone marrow aspiration rather than a bone marrow biopsy, the evaluation should be reported using 85097 (bone marrow; smear interpretation only, with or without differential cell count).
 
The other iron stain codes that you mentioned, 85535 (iron stain [RBC or bone marrow smears]) and 85536 (iron stain, peripheral blood), are clinical laboratory tests that do not involve physician interpretation. For example, code 85535 would be reported when a medical technologist evaluates the bone marrow iron stores, and a pathologist does not review it.