Pathology/Lab Coding Alert

Question: I-m trying to understand how to use codes for pathology consultation on specimens from another institution and would like advice on the following two scenarios: 1. We received a consultation request from another institution that included slides from a lumpectomy and axillary lymph nodes taken on the same day. 2. Our pathologist consulted with an outside lab on slides taken from a partial mastectomy performed in 2001 and a lymph-node FNA taken in 2006.


Texas Subscriber
Answer: Both cases require you to use 88321 (Consultation and report on referred slides prepared elsewhere). Because you do not indicate that the pathologist prepared any additional slides from submitted tissue, you would not use 88323 (Consultation and report on referred material requiring preparation of slides). You also don't mention a review of records, so you should not use 88325 (Consultation, comprehensive, with review of records and specimens, with report on referred material). What you need to decide in your two examples is how many units of 88321 you should report in each case. Unlike most other surgical pathology codes, the specimen is not the unit of service for 88321-88325. Rather, the unit of service is the surgical or cytological case. You should consider slides or material from different dates or different body sites as separate surgical -cases.- Do this: Code the two cases as follows: 1. Report one unit of 88321. Although your pathologist reviews slides from two specimens (breast and associated lymph nodes), they represent one surgical case from the same date of service. 2. Although this example also involves breast tissue and lymph nodes, you should report two units of 88321 because the pathologist consults on tissue taken at two separate times -- that is, two surgical cases.