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