Your CPT Questions

Reprinted from December 2002 CAP TODAY

Q: Can I report an evaluation and management code and an apheresis code when I perform an apheresis service and a separate evaluation and management service?

A: When the evaluation and management service is significant and can be identified separately, the evaluation and management service should be reported. An example of this is when evaluation and management services are performed during the initial consultation and evaluation to determine patient eligibility. Another example involves performing therapeutic apheresis in medically unstable patients, which often requires additional medical management to address fluid balance and transfusion needs. It may be appropriate in this case to report an evaluation and management service as well as the apheresis procedure.

Using the -25 modifier, Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service, with the evaluation and management code indicates that the patient’s condition required a significant and separate evaluation and management service, above and beyond the other service provided on the same day. Some insurers will deny claims if the -25 modifier is not reported with a necessary evaluation and management service when performed in conjunction with an apheresis procedure.

Before selecting an evaluation and management code, familiarize yourself with the evaluation and management section guidelines in CPT and the instructions preceding each code family. You must document evaluation and management services appropriately.

Q: I need to compare slides and reports from a mastectomy performed in 1998 and slides from a colectomy and liver biopsy performed in 2000 to a fine-needle aspiration biopsy of a lymph node from a third institution to assess the site of origin of recurrent tumor. What codes should I submit?

A: Consultations on referred material should be reported using codes 88321 through 88325. The unit of service for this series is the surgical pathology or cytopathology case, which might include multiple specimens for review. Use code 88321 if only slides are received and code 88323 if tissue blocks for preparation of slides are received. Code 88325 should not be used when the review of records is limited to the pathology reports.

Based on the services you described, code 88321 is the most appropriate code because only slides were received. Three units of 88321 should be reported because the code is used per surgical case and slides from three surgical cases were submitted.

The codes and descriptions listed here are from Current Procedural Terminology, a copyrighted publication of the American Medical Association. To purchase CPT books, call the AMA at (800) 621-8335.