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: Which codes should we use to report a fine needle aspiration that includes a cell block? We do not report the cell block separately, although the report might state, "1 block, 6 slides." Is it appropriate to charge for the cytology block? Does the number of slides change the coding?

New Jersey Subscriber   Answer: You can potentially use multiple CPT Codes for reporting fine needle aspiration (FNA).
 The removal of the cytology specimen through the needle is reported as 88170 (fine needle aspiration; superficial tissue [e.g., thyroid, breast, prostate]) or 88171 (& deep tissue under radiologic guidance), depending on the site. The service would not be reported by the pathologist if another physician carries it out (such as a radiologist would often do for deep-tissue FNA).
 
If the pathologist evaluates the aspirate to determine if there are sufficient cells for evaluation and diagnosis, the service is reported as 88172 (cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen[s]). The pathologist's final, interpretive evaluation of the FNA specimen is reported as 88173 (& interpretation and report). The code would be reported once, regardless of the number of smears that were prepared and evaluated from the FNA specimen.
 
In addition to smear preparation, the remaining aspirate may also need to be concentrated. If a cytospin is carried out on the specimen to concentrate cells, that service is reported with 88108 (cytopathology, concentration technique, smears and interpretation [e.g., Saccomanno technique]).
 
If a cell block is also prepared from the aspirate and is separately evaluated, it represents a separate service. The service would be reported as 88305 (level IV - surgical pathology, gross and microscopic examination cell block, any source) because cell block is a listed specimen in the surgical pathology codes. Again, because the specimen is the unit of service, 88305 would be reported once for the evaluation of the cell block, regardless of the number of slides prepared and examined from the block.