Pathology/Lab Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: How should I code cytologic examination of a bronchioalveolar lavage (BAL) with differential count? Should I report 88108 since I use a cytospin concentration technique, or CPT 89051 ?

Florida Subscriber
 

Answer: Report both codes if both services are provided. Code 88108 (cytopathology, concentration technique, smears and interpretation [e.g., Saccomanno technique]) reports cytologic evaluation of non-gynecological smears that have been concentrated using various methods, including thin prep or cytospin. Common sources for this service include fluids, washings and brushings such as BAL, cerebrospinal fluid (CSF) or peritoneal washings. This service involves concentrating the cytology specimen and preparing slides and stains to test for malignant cells.
 
If the physician orders a white count and differential on the same fluid, it would also be appropriate to report 89051 (cell count, miscellaneous body fluids [e.g., CSF, joint fluid], except blood). For example, if the BAL appears to indicate an infectious pathology rather than a tumor, the physician might want to get an idea of the presence and types of white cells. Note that the differential count would not be quantitative because of the dilution of the washing.
 
Although 89051 is more commonly used for body fluids such as CSF, it might be ordered for a BAL in some circumstances. The key is to report both the cytologic evaluation and the differential count if both services are provided.