Pathology/Lab Coding Alert

Question: Is it ever appropriate to separately bill two cytopathology methodologies for the same specimen if we can document the necessity of two methods to reach a diagnosis? For example, if we examine direct smears from pleural fluid, then determine that we need to concentrate the remaining fluid with cytospin method and examine the concentrated smears, can we separately report the direct smear and concentrated smear methodologies?


Florida Subscriber


Answer: Although in the past coding experts recommended that you could separately report two different cytopathology services for the same specimen when medically necessary, more recent instruction from Medicare says, no, you cannot do so. You should not report together 88104 (Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation) and 88108 (Cytopathology, concentration technique, smears and interpretation [e.g., Saccomanno technique) in the example you gave, because you only have one specimen. Instead, you should select the most extensive procedure code, which in this case is 88108.

In the most recent version of NCCI edits , Medicare states, "for a given [cytopathology] specimen, only one code from a group of related codes describing a group of services that could be performed on a specimen with the same end result (e.g. 88104-88112, 88142-88143,88150-88154, 88164-88167, etc.) is to be reported."

NCCI goes on to clarify that you can only override the edit pairs that prohibit reporting these codes together if the lab performs the different cytopathology services on two separate specimens. In that case, you can override the edit pair by using modifier -59 (Distinct procedural service).

Although Medicare makes it clear that you cannot separately report two cytopathology methodologies for the same specimen, even when medically necessary, you should check with your non-Medicare payers to see if they still allow you to separately bill.

You can access the NCCI Policy Manual, Chapter 8, which states this cytopathology policy, on the Internet at http://www.cms.hhs.gov/physicians/cciedits/nccmanual.asp.