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September 2006
PAP/NGC Programs Review

Q: A 65-year-old man presents with a solitary lung nodule. The radiologist performs a CT-guided core biopsy of the lesion and requests an intraoperative assessment of specimen adequacy. The pathologist performs a touch preparation in the CT suite and renders a diagnosis of “non-small cell carcinoma.” The core is then processed for routine histology. The following day, the core biopsy sections confirm the results of the intraoperative assessment. What are the appropriate charge codes for this case?

A. The correct charge codes are:

  • 88305, Level IV-Surgical pathology, gross and microscopic examination,
  • 88333, Pathology consultation during surgery: cytologic examination (e.g., touch prep, squash prep), initial site.

Recently, the American Medical Association implemented changes in coding for intraoperative cytologic exams. In the past, the AMA’s Current Procedural Terminology, or CPT, did not have a specific code for intraoperative consultations with touch prep. As a result, many pathologists used the 88161 touch prep code and a 59 modifier, along with the 88329 intraoperative consultation without frozen section code, to account for intraoperative touch preparations.

The new 88333 and 88334 codes, which went into effect Jan. 1, 2006, render the practice of using a combination of 88329 and 88161 obsolete. The new codes are to be used when an intraoperative touch preparation or squash preparation is performed, with 88333 used for the initial site and 88334 used for each additional site. These are “stand-alone” codes that do not require the use of 88329, as the time and work for the gross evaluation portion of the evaluation is included in 88333 (and 88334).

The 88333 and 88334 codes can be used in combination with the 88331 frozen section code, provided that both frozen section and cytologic evaluations are required for diagnosis. If the frozen section (88331) and the cytology evaluation (88333) are complementary, only one may be used. As always, the final report should document what procedures were necessary and thus provide justification for the CPT codes employed.

These new codes should not be used when determining adequacy of fine-needle aspiration specimens. For FNAs, pathologists should continue to use 88172 for the adequacy check and 88173 for the final interpretation and report.

Jonathan Hughes, MD, PhD
Laboratory Medicine
Consultants, Ltd.
Las Vegas
Member, CAP
Cytopathology Committee