Pathology/Lab Coding Alert

Question: When our pathologist examines a trichrome stain on a fecal smear for ova and parasites, how should we report the service?


Indiana Subscriber


Answer: For the direct fecal smear, the lab should report microbiology CPT 87177 (Ova and parasites, direct smears, concentration and identification). A CPT text note following 87177 directs you to 88313 for a trichrome stain on the smear. This advice presents a coding dilemma for two reasons:

1. Although +88313 (Special stains [list separately in addition to code for primary service]; Group II, all other [e.g., iron, trichrome], except immunocytochemistry and immunoperoxidase stains, each) lists trichrome as an example, trichrome for ova and parasites is actually a micro-organism stain (+88312, Special stains [list separately in addition to code for primary service]; Group I for micro-organisms [e.g., Gridley, acid fast, methenamine silver], each). In fact, the same CPT note cross-referenced code 88312 instead of 88313 until the 2002 CPT revision. See "Watch for 3 Complications When Coding Special Stains" earlier in this issue for a complete discussion of special stain names and coding.

2. CPT lists surgical pathology codes 88312 and 88313 as add-on codes for a "primary service." Pathologists can have an especially hard time getting paid for the trichrome stain for ova and parasites because they usually don't look at the direct smear, so they have no primary service to report.

Current solution: Today, pathologists can overcome this dilemma by reporting the professional component (using modifier 26) of 87207 (Smear, primary source with interpretation; special stain for inclusion bodies or parasites) for interpreting the trichrome stain with an ova and parasite smear. "Code 87207 is on Medicare's list of 18 lab tests that are approved for pathologist interpretation and professional component billing, so that's the way to go," says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc., a pathology business- practices publishing company in Simpsonville, Ky.

New solution: CPT 2006 should solve this dilemma by providing a new code for microbiology complex special stains. See "Say Goodbye to 88313 with Fecal Ova and Parasites" on page 77 to learn all about it.