Pathology/Lab Coding Alert

Question: The pathologist performed a puncture aspiration of a cyst in the patient’s right breast that required ultrasound guidance for needle placement. The pathologist then performed the aspirate exam using selective cellular enhancement. How should we code this?

Montana Subscriber

Answer: The correct code for a breast cyst puncture aspiration is 19000 (Puncture aspiration of cyst of breast). The code does not include ultrasound (US) guidance, so that’s separately billable as 76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation).

Caution: The entity that performs the aspiration and the US guidance should bill for their work, if it’s not done by the pathologist.

For the pathology (cytology) evaluation of the aspirate that involves cellular enhancement, such as a liquid based cytology smear, report 88112 (Cytopathology, selective cellular enhancement technique with interpretation (eg, liquid based slide preparation method), except cervical or vaginal).

Pitfall: Pathologists often perform fine needle aspiration (FNA) of breast. Although the procedures and the specimens are very similar, FNA is a totally different coding scenario than a cyst puncture aspiration. Make sure you know the difference when you’re coding a pathology report — and query the pathologist if the procedure and specimen are not clear.

FNA alternative: If this case had involved an FNA procedure and specimen, the coding would be as follows:

• 10005 (Fine needle aspiration biopsy, including ultrasound guidance; first lesion) for the aspiration. Notice that this code includes the US guidance.
• 88173 (Cytopathology, evaluation of fine needle aspirate; interpretation and report) for the cytology evaluation. Don’t add 88112 for the cellular enhancement. The 88173 service includes all smear preparation and evaluation for the single specimen.