Pathology/Lab Coding Alert

Question: How should we report a Tzanck stain for herpes? Should we report it as special stain for microorganisms (88312) even though the source is a fever-blister smear, not a surgical pathology tissue sample? Mississippi Subscriber Answer: More commonly referred to as a Tzanck smear or Tzanck preparation, this procedure is not a type of special stain so much as it is a type of special smear preparation. Labs might use different stains such as Wright stain or Pap stain for the smear. For a Tzanck preparation such as you described in your question, the physician scrapes cells from a blister or ulcer and smears them on a microscope slide, which the lab then stains and examines for characteristic changes caused by herpes virus. The changes include giant cells with multiple nuclei and cells with small, dark areas called inclusion bodies.

The correct code for this procedure is 87207 (Smear, primary source with interpretation; special stain for inclusion bodies or parasites [e.g., malaria, coccidia, microsporidia, trypanosomes, herpes viruses]). Although a cytotechnologist often reports the results, noting the presence or absence of inclusion bodies, a pathologist may interpret the test results for this procedure. The pathologist should report the interpretation service by appending modifier -26 (Professional component) to 87207. This is the only code from the 87205-87210 code family for which Medicare allows you to use modifier -26.

CPT does not restrict the use of special stain codes 88312-88314 (Special stains [list separately in addition to the code for surgical pathology examination]; ...) to surgical pathology specimens - in fact, a note following 87207 in the CPT manual states, "For complex special stains, see 88312, 88313." In the case of a Tzanck smear, however, you should report the more specific code, 87207.