Reprinted from August 2004 CAP TODAY
Q: How should I code an evaluation of a bronchoalveolvar lavage for
Pneumocystis prepared by cytospin and a Gomori methenamine silver, or
GMS, staining technique?
A: Report the cytospin preparation as code 88108, Cytopathology,
concentration technique, smears and interpretation (eg, Saccomanno technique).
GMS staining is commonly used to identify fungal and Pneumocystis organisms
and can be reported separately as code 88312 Special stains (List separately
in addition to code for primary service); Group I for microorganisms (eg,
Gridley, acid fast, methenamine silver), each. Add-on code 88312 was
revised editorially in CPT 2004 to instruct users to report special stains
performed appropriately in addition to procedures other than surgical
Before this year, the wording of codes 88312 to 88314 was misinterpreted
to indicate that these codes were only to be used in conjunction with
surgical pathology specimens (88302 to 88309). However, this was not the
intent of codes 88312 to 88314. For example, code 88312 could be billed
with code 87101 on a toenail specimen also submitted for culture.
Q: Under what circumstances should we use modifier –59?
A: Modifier –59, Distinct Procedural Service, is used to
identify procedures or services that are not typically reported together
but that are appropriate under the circumstances. When performing pathology
services, modifier –59 should be used to report procedures that are distinct
or independent. For example, say a lab receives a bronchial washing and
a bronchial brushing. It uses a thin-layer preparation technique to perform
the bronchial washing and make a direct smear of the brushing. Because
the preparations being evaluated are from two distinct specimens, the
lab would report both the directly prepared smear and the cellular enhancement
preparation as separate services using codes 88112, Cytopathology,
selective cellular enhancement technique with interpretation (eg, liquid
based slide preparation method), except cervical or vaginal and 88104,
Cytopathology, fluids, washings or brushings, except cervical or vaginal;
smears with interpretation. In such a situation, modifier –59 should
be appended to CPT code 88104 to inform the payer that the services are
separate, not unbundled.
Another example is if a urine sample is submitted the same day as a bladder
washing and biopsy. The urine is prepared by ThinPrep technique (88112)
and the washing is prepared by cytospin (88108–59). The cell block and
biopsy are billed separately as 88305. Modifier –59 is required to indicate
that different levels of service were provided for different specimens.
Modifier –59 is also appropriate when performing the same procedure for
a different specimen that uses the same CPT code.
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 2004. CPT 2004 is copyrighted by the American Medical Association.
To purchase CPT books, call the AMA at 800-621-8335.