Q: We receive cervical biopsies along with
an endocervical curettage, which is a brushing of the endocervix without
tissue that is submitted in CytoLyt solution. We process the endocervical
brushing specimen as ThinPrep slides, but these are not considered Pap
smears. Can we bill this as a nongynecologic specimen even though it is
a cytology of a gynecological site?
A. The correct code for reporting an endocervical brushing
submitted in CytoLyt solution and processed using a ThinPrep processor
is CPT code 88112, Cytopathology, selective cellular enhancement technique
with interpretation (eg, liquid based slide preparation method), except
cervical or vaginal. This diagnostic code is most appropriate because
it denotes both the special technical preparation and interpretation necessary
for an endocervical brushing with ThinPrep slide preparation.
If a cell block only is prepared, use CPT code 88305.
If a cellular enhancement preparation and cell block are prepared, use
CPT codes 88112 and 88305. Alternatively, this specimen may be processed
as cytocentrifugation preparations and coded as 88108 with or without
a cell block.
Q: When our laboratory sends out surgical
pathology slides for expert consultation, it covers the charges unless
the patient has specifically requested a second opinion. Our understanding
has been that if a pathologist requests the consultation, it is the responsibility
of the lab to cover the cost of the consultation. However, a staff member
from one of our consulting laboratories recently informed one of our employees
that we could pass along consultation charges to the patient or patient’s
insurance. Is this true?
A. In an ideal situation, the patient is informed of
the diagnostic challenge and the value of the slides being sent to an
expert. In such circumstances, it is appropriate to bill the patient or
patient’s insurance for the service. When the pathologist thinks
it is in the patient’s best interest to get a consultation, the
clinician/surgeon should be part of the discussion of the patient’s
slides and the need for expert consultation. In those circumstances, it
is appropriate to bill the patient or patient’s insurance. If the
pathologist is seeking the consultation for internal quality assurance/quality
control reasons, the patient should not be charged.
It is good patient care for all anatomic pathology
labs and hospitals to have a budget for such situations and for the patient
who cannot afford but needs an expert opinion. The designated budget would
represent a small fraction of the amount of resources spent each day in
the lab for such activities as chemistry QA/QC.
Frequently asked questions about CPT are published bimonthly in “Capitol
Scan.” This section of CAP TODAY is a product of the CAP Economic
The codes and descriptions listed here are from Current Procedural
Terminology, 4th ed., CPT 2006. CPT 2006 is copyrighted by the American
Medical Association. To purchase CPT books, call the AMA at 800-621-8335.
For more information about CPT coding, visit the CPT
Coding Resource Center on the CAP Web site.