Question FNA/FNAB - Can you bill 88173 and 88305 if no cell block was created but tissue was submitted

llg2020

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Hi there!

I have a pathology coding question that I'm hoping you can help get answered.

Can you bill an 88305 and an 88172 if a cell block wasn't created but tissue was submitted for microscopic examination? Some believe you cannot bill for cytologic and surgical pathology CPT codes on the same specimen (in other words, not bill for the 88305 and just bill for the 88172/88173 even if tissue was submitted but cell block was not created from fluid).

More background info.. we are starting to seeing a new procedure where a fine needle aspirate needle is used to obtain a tissue sample. Along with the tissue sample, there is usually fluid in the needle as well that is also used to help render either a diagnosis or immediate adequacy check.

This particular procedure goes as follows: A hollowed out needle, like the one used for regular FNA's is inserted into the patient, a piece of gastric tissue is removed, and the needle contents is given to the pathologist in the OR. The following scenarios are possible options of what could happen next:

  • Scenario A: the tissue is removed from the needle and placed in formalin for it to be submitted in a cassette. The needle contents are then, for lack of a better word, squirted onto a slide and smears are created for immediate adequacy studies. The pathologist uses the smears prepared to determine whether spindle cells are present or not, and the information is relayed immediately to the surgeon. No fluid is submitted for cell block preparation.
    (appropriate codes:
    88305 x 1- tissue submission and
    88172 x 1 - immediate evaluation of cytologic fluid ?)

  • Scenario B: the contents of the needle are, again for lack of a better word, squirted onto a slide. Tissue is removed and placed in formalin for it to be submitted in a cassette. The fluid on the slide is used to create a smear for immediate adequacy check. No fluid is submitted for cell block preparation.
    (appropriate codes:
    88305 x 1- tissue submission and
    88333 x 1 - immediate evaluation of TP, since tissue was placed on slide used for smear review prior to being submitted into individual cassette. ?)

  • Scenario C: tissue is removed from the needle and placed in formalin for it to be submitted in a cassette. Some of remaining needle contents are placed on slide for immediate evaluation, and the rest is submitted in cytorich media for cell block.
    (appropriate codes:
    88305 x 1- cell block
    88172 x 1 - immediate evaluation of cytologic fluid
    88173 x 1 - fna review?)

The main question, I believe, is can you bill an 88305 and an 88172 if a cell block wasn't created but tissue was submitted for microscopic examination? Some believe you cannot bill for cytologic and surgical pathology CPT codes on the same specimen (in other words, not bill for the 88305 and just bill for the 88172/88173 even if tissue was submitted but cell block was not created from fluid).

Any help would be greatly appreciated!

Thank you,
 

danachock

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Hi llg2020,

Cytology coding can be very confusing at times, but I may be able to help. Needle core biopsies do occur all the time.

If a true fine needle aspiration did occur; documentation would need to support billing any FNA charges (88172/88173). It needs to state that "fine needle aspiration ......"

Look at your pathology report - what does it state?
Under the "gross description" what was received?

If it states "slides received" - then you will bill 88173 along with any immediate assessment (88172) if applicable

IN MY OPINION - If tissue was submitted separately for a gross and microscopic interpretation you would bill the appropriate biopsy code (based on location).

Example: if it states 3 core biopsies received measuring .7x.8x.8 measurements in aggregate from a location within the patient's body you would code the 8830x (depending on location - stomach, pancreas, lung, liver, etc for the tissue biopsy) and rapid assessment would be 88333 with 88334 (if appropriate).

I'm only here to help, if you wanted to throw a pathology report here with no PHI.
I know that I code many cytology and surgical cases that all occur on the same DOS (for example: lung FNA, lung biopsy, lymph node sampling bx all with different accessioning numbers). But, hmm - I also did wonder if this may be just a accessioning issue at your facility.

Thank you for listening,
Have a great evening.
Dana Chock, RHIT, CPC, CANPC, CHONC, CPMA, CPB
Coding Specialist 3 - Pathology
Coding Analyst & Denial Specialist
 

danachock

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I am bursting at the seams with exciting news to share regarding cytology coding! I have asked Dr. Dianne Kendall, MD (Duluth, MN) to speak virtually for our local chapter meeting on 6/1/2021 at 530 pm (CST) and she agreed today and I just submitted our chapter's "event request". She is such a phenomenal speaker and has presented for our chapter several years for our "MayMania" meeting and has provided us numerous tours to the pathology department. Which will not happen this year. Dr. Kendall really has a niche about explaining pathology and makes it so interesting and ALSO knows how to assign proper code assignment for CPT charges too. I don't have the details yet because I just submitted my event request a few moments ago today, but anyone that is interested in attending please visit our local chapter website Brainerd, MN for additional details if you would like to attend this exciting event!! I hope to see you there!!
 
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