Pathology/Lab Coding Alert

NCCI bundles many cytopathology and consultation codes

You can no longer bill touch preps or related services with many pathology consultation codes, according to the latest National Correct Coding Initiative edits , version 10.0. Because pathologists often perform these cytology exams with intraoperative or referred-material consultations, you'll need to know when you can override the new edit pairs. 
 
The new bundles involve the following cytopathology codes:

 

 88160 - Cytopathology, smears, any other source; screening and interpretation
 

 88161 - ... preparation, screening and interpretation
 

 88162 - ... extended study involving over 5 slides and/or multiple stains.

No Touch Preps with Referred Material

"You can't bill touch preps (88161) with consultations on referred material, according to NCCI version 10.0," says R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark. The new edits bundle touch preps with each of the following codes:

 

 88321 - Consultation and report on referred slides prepared elsewhere
 

 88323 - Consultation and report on referred material requiring preparation of slides
 

 88325 - Consultation, comprehensive, with review of records and specimens, with report on referred material.


Sometimes labs legitimately perform these services together. For example, a pathologist may perform a referred-slide consult from a past surgery for a patient who is scheduled for a current surgery. "If the pathologist reviews a touch prep from a new specimen on the same day as the slide consult, you should report both 88161 and 88321 using modifier -59 [Distinct procedural service]," Stainton says. By listing these code pairs with a "1" modifier indicator, NCCI 10.0 allows you to use a modifier to override the edits for separate specimens. 

Edits Bundle Intraoperative Consultations

NCCI 10.0 also bundles some of the 88160-88162 cytopathology codes with the family of intraoperative pathology consultation codes (88329-88332). You should no longer report parent code 88329 (Pathology consultation during surgery) with 88162. Nor should you report any of the codes 88160-88162 with the rest of the surgical pathology consult family: 88331 (... first tissue block, with frozen section[s], single specimen) or 88332 (... each additional tissue block with frozen section[s]).
 
"Although in the past we might have evaluated both touch preps (88161) and frozen sections (88331-88332) during the same surgical consultation, we can no longer report those services together," Stainton says. Although listed with a 1 modifier indicator, you can only override these edit pairs with modifier -59 if the pathologist performs frozen sections and touch preps on different specimens.
 
"Pathologists can continue to bill touch preps with an intraoperative pathology consultation without frozen sections (88329)," Stainton says. Although CMS originally proposed bundling 88329 with 88160-88162, NCCI 10.0 only pairs 88329 with 88162, thanks to successful lobbying by the College of American Pathologists.