CPT code 88172 is defined as “Cytopathology,
evaluation of fine needle aspirate; immediate cytohistologic study to determine
adequacy of specimen(s).”1
This code can be billed only for the interpretation of adequacy for fine needle aspirations. The code is extremely limited in scope; it can be used only for fine needle aspirates. It cannot be used for touch preparations of core biopsies, adequacy assessments for brushings, or smears performed without fine needle aspirates.2 Unfair? Maybe, but the code is narrowly defined.
What about the case in which a cytotechnologist is sent to assist a clinician in the radiology suite for FNA? While a cytotechnologist may prepare the smears and ancillary preparations, and he or she may even evaluate the smears, an 88172 cannot be billed for the cytotechnologist’s services. The 88172 code should not be used to report the assistance of a technologist during FNA—88172 is a physician service code.3 If the cytotechnologist prepares the material and screens the slides, and the pathologist then interprets the smears immediately (at the time of the aspirate), an 88172 can be charged. If a pathologist does not interpret the preparation immediately for adequacy, an 88172 cannot be billed. That an 88172 cannot be billed when a cytotechnologist performs an adequacy assessment is not a reflection of the capabilities or professionalism of a cytotechnologist; it is simply the manner in which the code is defined. 88172 is a physician service code.
There is confusion about the technical component of an 88172. Though a relative value unit, or RVU, is assigned to 88172 as a technical component, it is not to be construed as a “technologist” component. The “technical” portion of an 88172 is the RVU it takes to prepare the specimen for review. If there is no physician determining immediate adequacy, the technical component is not a “stand-alone” charge.
What about during endoscopy, when a bronchial brushing smear is made and the pathologist is asked to review the slide for adequacy? Because it is not a fine needle aspirate, an 88172 cannot be billed. The same is true for bile duct brushing, gastrointestinal brushings, or the rare mucosal scraping. Unless the cytologic material is from a fine needle aspiration, an 88172 cannot be billed for rapid assessment of adequacy.
What about the assessment of adequacy for a touch preparation of a core biopsy?
Correct again! 88172 cannot be used for touch preparations of core biopsies.
Luckily, we now have an available code for such purposes: An 88333 is the code
to use for touch preparations, and an 88334 is used for additional touch preparations
of a core biopsy (more than one touch preparation). (Related article: PAP/NGC
by Jonathan Hughes, MD, PhD, for a review of the touch preparation
How many 88172 codes can be billed? 88172 can be used as many times as a pathologist is asked to assess adequacy. If a lung aspiration is performed, and the pathologist is asked to assess three separate passes from the lung, an 88172 can be billed three times. Assuming only one site is aspirated, that would mean 88172 times three and a single 88173 (for the final interpretation). If three smears are made from one pass, only a single 88172 can be charged. It is not the number of slides reviewed; rather, it is the number of passes into the site that the pathologist is asked to assess for immediate adequacy that defines the number of times an 88172 can be used.
Here’s another scenario: If a right upper lobe and right lower lobe lung FNA are performed, and a single pass is performed at each site, and a pathologist is asked to review a pass from each site for adequacy, an 88172 can be used for each adequacy assessment. An 88173 is also billed for each site in which a final diagnosis is rendered. In the case of a right upper and right lower lobe biopsy in which the pathologist is asked for an adequacy assessment, an 88172 and 88173 can be used twice (one for each site). Of course, the report must document that two separate sites were sampled and that each site was assessed for adequacy, and that a final diagnosis was rendered for each site.
Use of the 88172 CPT code is narrowly restricted. It can be used only in the instance when a physician evaluates a fine needle aspiration for adequacy, at the time of the procedure. It cannot be used if a cytotechnologist performs the assessment or for brushings, non-FNA smears, or touch preparations. Whatever you do, be careful when using an 88172.
- Current Procedural Terminology. American Medical Association, copyright 2006.
- Spires S, Mody DR. Billing and coding in cytopathology: deciphering the alphanumeric soup. CAP TODAY. June 2005: 58–63.
- Graziano C. Cracking the code: advice for CPT dilemmas. CAP
TODAY. July 1999: 1+84–90.
Dr. Moriarty, vice chair of the Cytopathology Committee, is with AmeriPath Indiana, Indianapolis.