Pathology/Lab Coding Alert

Question: When our pathologist receives a request for consultation on slides submitted from another institution, we're uncertain about the unit of service. If the tray includes slides from different surgical procedures - for example, a specimen from 1999 and a different specimen from 2002 - should we bill one unit of CPT 88321 , or two units?

Arizona Subscriber

Answer: In your example, you should bill two units of 88321 because the slides are from two different surgeries on separate dates. The unit of service for consultation code 88321 (Consultation and report on referred slides prepared elsewhere) is the accession, or surgical case, not the specimen. Multiple slides or specimens from a single patient may comprise one or more accessions depending on the original surgical date and the body area from which the specimen(s) came.
 
For example, if the slides involve a prostatectomy and regional lymph node resection from the same patient on the same day, you should report one unit of 88321 because the slides represent one surgical case.
 
On the other hand, if the slides represent a lesion excision from one date, and a margin re-excision from a later date, you should report two units of 88321. Different dates indicate different accessions.
 
Different body sites may also indicate different accessions. For example, if the slides are from a breast-lesion fine needle aspiration and a skin excision taken from the same patient on the same day, you should report two units of 88321. 
 
Your carrier may require you to report multiple units of 88321 with modifier -59 (Distinct procedural service) to indicate that you performed two separate consultations and are not double-billing.