88112 vs 88305

beariejules

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We sent a urine sample to a path lab to do a 88112 - CNS-Cytopathology, selective celluar enhancement tech w/interp. They also charged a 88305 - Level IV surgical pathology, gross & microscopic exam. The lab said they used the 88305 to do a cell block. Myself and other coders that I have talked to do not think this is correct. The 88305 is a biopsy surgical path code. We did not send any tissue only a urine sample to do the CNS (88112)

We believe that the path lab is incorrectly charging the 88305. I would appreciate anyone's input on this.

Thanks,
Julie :)
 
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Cell Block

A cell block is common with various specimens such as Thin preps (88112) and also created from washing of FNA's. The cell block is a listed CPT specimen code. Cell block, any source. 88305.

The lab is correct in using the code.

I hope this is helpful.

Darcy Hughes, CPC
 
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Good evening, a cell block can be billed as an adjunct preparation, granted with proper documentation. Below is a snip it from the Path handbook.

Cell Block, Any Source (88305). The term refers to a paraffin block containing suspended
tissue cells, commonly developed and examined as an adjunct preparation in conjunction with
fine needle aspirate, nongynecological cytology, and bone marrow aspirate specimens. The
phrase “any source” is to be read literally: it makes no difference whether the source of the cell
block is a cytologic or hematologic specimen, this descriptor applies. Furthermore, the cytologic
source doesn’t have to be of the nongynecologic variety: the AMA confirms that a cell block
examined as an adjunct preparation with a liquid-based Pap test (gynecologic cytology) is also
separately reportable with 88305. {AMA CPT-IS, KB #1434, Nov. 2, 2007} Cell block, any
source is listed in CPT under code 88305 (Level IV).

A cell block is prepared in the lab at the request of the pathologist who’s responsible for a
given cytology or bone marrow case. Hence, there’s no doubt what the specimen is, but you must
ensure that the pathology report documents the fact that a cell block was prepared and examined.
(Failure to include proper mention of the cell block in the report may lead to allegation of false
claim, or worse.) Once you’ve verified the documentation, unconditionally report code 88305 for
Cell block (irrespective of source): no fact, consideration, or complication changes the code.
A cell block is solely an adjunct preparation, so there’s always a primary specimen charged
in addition to it: the primary preparation might be a fine needle aspirate smear (88173), some
other nongynecological cytology smear (88104, 88108, 88112 or 88160, for example), or a bone
marrow aspirate smear (85097). (In theory, it’s possible to get a readable cell block slide with an
acellular primary smear that can’t be charged due to medical necessity such that you’d bill 88305
for the cell block but nothing for the smear, but that scenario is rare—handle it in a reasonable,
prudent way if it should ever arise in your lab.) The code combination that requires a ‘separate
procedure’ modifier for Medicare accounts is 88305 and 88160-88162 (append the modifier to
the cytology code); see Appendix 6 for details.

Recent instruction from the AMA indicates you can bill only one cell block charge (one unit
of 88305) per primary source specimen, even though two or more cell blocks may actually be
prepared and examined from the available material. {CPT Assistant, July 2005} For example, if
two cell blocks are prepared and examined with a bone marrow aspirate, you’ll bill only one unit
of 88305, plus the aspirate smear charge (85097). On the other hand, if you prepare and examine
a cell block in conjunction with each of two lung FNA specimens (bilateral FNA), you’ll report
88305 x 2 and 88173 x 2 for the work.

It doesn’t make any difference whether the cell block is diagnosed in the same medical report
as the primary specimen, or in a separate histopathology report: the only thing that matters is that
the cell block is diagnosed in a document that ends up in the patient’s medical chart.
You’ll never see an intraoperative consultation in relation to a cell block, but you will find a
special stain or immunoperoxidase documented for that preparation from time-to-time. Add-on
procedures are separately chargeable with a cell block, the same as any other specimen.
 
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