Pathology/Lab Coding Alert

Question: Our pathologist examined a liver biopsy, evaluating H&E stained tissue for morphology to help distinguish metastatic carcinoma from primary hepatocellular carcinoma. The pathologist also evaluated a mucicarmine stain. Based on morphology and observation of focal mucin production, the pathologist diagnosed the patient with breast cancer, metastatic to the liver. The patient is not under current treatment for breast cancer. How should we code this?  

Michigan Subscriber

Answer: The appropriate codes for the liver biopsy exam is 88307 (Level V - Surgical pathology, gross andmicroscopic examination … Liver, biopsy - needle/wedge …).

For the mucicarmine stain, report 88313 (Special stain including interpretation and report; Group II, all other [e.g., iron, trichrome], except stain for microorganisms, stains for enzyme constituents, or immunocytochemistry and immunohistochemistry). You should not bill separately for the hematoxylin and eosin (H&E), which is a standard tissue stain.

The appropriate ICD-10 code for this case is C78.7 (Secondary malignant neoplasm of liver and intrahepatic bile duct). You should not report the findings as C22.- (Malignant neoplasm of liver and intrahepatic bile ducts…), because the pathologist did not find a primary liver cancer. Approximately 10 percent of liver cancers are adenocarcinomas metastatic from breast.