Pathology/Lab Coding Alert

Question: Our lab has begun a new protocol for temporal artery biopsies based on research indicating enhanced identification of temporal arteritis. We now perform an elastic stain on three separate levels for each biopsy. How should we report these services? Should we include one unit of the special stain code, or three? California Subscriber Answer: For the arterial biopsy pathology exam, you should report 88305 (Level IV Surgical pathology, gross and microscopic examination, artery, biopsy). The elastic stain, such as a Verhoeff's Van Gieson stain, is useful to evaluate the changes in elastic fibers in vascular diseases such as temporal arteritis. Report the elastic stain as +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).

Despite the fact that you perform multiple stains at separate levels, you should report only one unit of 88313. Like other surgical pathology codes, the unit of service for the special stain codes is the specimen. In this case, the specimen is the artery biopsy. You should report the stain once per specimen, regardless of the number of tissue blocks or slides prepared.

The definition for 88313 uses the word "each," indicating that you should report the code once for each stain used. You would report multiple units of 88313 only if you used different types of stains, not if you prepared and evaluated multiple slides using the same stain.