Pathology/Lab Coding Alert

Question: The pathologist performed four touch preps on the margins of a lesion excision. He found one margin positive for tumor and reported the findings during surgery, so the surgeon re-excises the positive margin, and the pathologist performs another touch prep and reports the margin clear. How should we code this?


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Answer: The initial excision includes four -sites- of touch preparations, to use the CPT terminology. That's why you should report the initial excision as 88333 (Pathology consultation during surgery; cytologic examination [e.g., touch prep, squash prep], initial site) plus three units of 88334 (- cytologic examination [e.g., touch prep, squash prep], each additional site).

Once the pathologist gets a re-excision, you-re dealing with a separate touch-prep specimen, and you should begin counting sites again. For the re-excision, the pathologist performs a touch prep on only one site, which you should report as a single unit of 88333.

Thus, the pathologist would bill 88333 x 2 and 88334 x 3 for the intraoperative consultations he performed for that patient on that day.

Heads up: You should not use the other CPT touch-prep code 88161 (Cytopathology, smears, any other source; preparation, screening and interpretation) when your pathologist performs the touch preps as part of an intraoperative consultation. CPT added codes 88333 and 88334 in 2006 to describe touch preps used as part of a surgical consultation.