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Pathology/Lab Coding Alert

Should You Use 88112 for All Non-Gyn Thin Preps?

Published on Mon Jan 26, 2004

New CPT code raises more questions than it answers

Although the code is only months old, controversy already surrounds 88112 (Cytopathology, selective cellular enhancement technique with interpretation [e.g., liquid- based slide preparation method], except cervical or vaginal), introduced in CPT 2004.
 
The example given in this non-cervical/vaginal cytopathology code - liquid-based slide preparation method - might lead you to report 88112 for all non-gyn thin layer preparations. But until the AMA provides further direction, you'd better report 88112 only for non-gyn liquid cytology that includes the process described in the code definition - selective cellular enhancement technique.
 
One thing is certain, "Code 88112 provides a method-specific code for at least some thin layer preparations from non-gyn sources, just as cervical sources have had for years," says Beth McDevitt, CPC, coding and audit specialist with Pathology Service Associates LLC (PSA), a nationwide organization headquartered in Florence, S.C., that provides coding, compliance, billing and marketing services to pathologists.

Choose Code by Method

Code 88112 describes cytopathology smears involving concentration and cellular enhancement from sources such as urine and cerebral spinal fluid or bronchial specimens. It joins other method-driven codes for non-gynecological cytopathology sources. CPT already had codes in place for filter method and concentration techniques:

 

  •  88106 - Cytopathology, fluids, washings or brushings, except cervical or vaginal; filter method only with interpretation
     
  •  88107 - ... smears and filter preparation with interpretation
     
  •  88108 - Cytopathology, concentration technique, smears and interpretation (e.g., Saccomanno technique).

    Codes 88106-88107 specify the source as fluids, washings or brushings. Code 88108 may refer to concentration of a sample from these sources or other non-gynecological sources such as sputum. Concentration methods include cytospin and Saccomanno technique. Prior to 88112's introduction, coders reported non-gyn thin layer preparations using code 88108.
     
    "The difference between 88108 and 88112 is that in addition to concentration, the 88112 technique involves selective enrichment of the desired cells," McDevitt says. "That may involve removing background debris such as blood cells, mucous, or inflammatory cells that otherwise obscure the cells the pathologist needs to evaluate." This "selective cellular enhancement" is at the heart of the controversy.
     
    "The 88112 code definition is a bit confusing because it uses 'liquid-based slide preparation' as an example, but at the same time, not all such preparations result in selective cellular enhancement," says Elizabeth Sheppard, HT (ASCP), manager of anatomic pathology at Wake Forest University Baptist Medical Center in Winston Salem, N.C.
     
    Not every specimen contains debris that a liquid-based method must remove to selectively "enhance" cells for interpretation. Yet commercial liquid-based cytology such as SurePath or ThinPrep has the ability to concentrate diagnostic material and remove background contaminating debris by washing, filtration, centrifugation and/or gravity dispersion.
     
    In its "Rationale" for code 88112 published in CPT Changes 2004 An Insider's View, the AMA states:
    Code 88112 was added to describe new cellular enhancement technologies that allow both concentration and enrichment of cytology specimens. Because these cellular enhancement techniques have the ability to concentrate diagnostic material and remove background contaminating debris, they now can be used on complicated specimens that could not be evaluated with typical concentration techniques.

    Maybe the AMA intended for coders to report 88112 whenever a lab performs a non-gyn liquid-based cytology that "allows" enrichment or "has the ability to" remove background contaminating debris, whether or not the automated system actually accomplishes those ends for a particular specimen.
     
    "But I am very reluctant to advise our PSA clients on the use and intent of this new code until I have further clarification and specific examples from the AMA," McDevitt says. Absent such clarification and examples, you would continue reporting 88108 for non-gyn liquid-based cytology that does not involve selective cellular enhancement if you interpret the code definition conservatively.
     
    In any event, don't report 88108 and 88112 together, according to a CPT note following code 88112. "The concentration described by 88108 is part of the 88112 service, so you shouldn't report both codes for the same service," McDevitt says.

    Cervical Cytology Has Separate Thin Prep Codes

    CPT has long distinguished thin layer preparation codes for cervical and vaginal specimens. Report liquid-based cervical cytology using one of two code families: manual screening codes 88142-88143 (Cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin layer preparation; ...) or automated screening codes 88174-88175 (Cytopathology, cervical or vaginal [any reporting system], collected in preservative fluid, automated thin layer preparation; ...).
     
    Use these other code families for traditional Pap smears: 88147-88148 (Cytopathology smears, cervical or vaginal; ...), 88150-88154 (Cytopathology, slides, cervical or vaginal; ...), or 88164-88167 (Cytopathology, slides, cervical or vaginal [the Bethesda System]; ...)

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