Q: How should I code an evaluation of a bronchoalveolar 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
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 2006. CPT 2006 is copyrighted by the American
Medical Association. To purchase CPT books, call the AMA at 800-621-8335.
For more information about CPT coding, visit the CPT
Coding Resource Center on the CAP Web site.