CPT Questions

April 2005

Q: We received a vertebral cytologic specimen for which the radiologist supplied us with a core biopsy, fine-needle aspiration smears, and the residual FNA fluid for a patient being evaluated for metastatic carcinoma. The radiologist did not indicate that these came from different sites so we assumed they came from the same general area. Can we use code 88305 for the core biopsy, 88311 for the decalcification procedure, 88173 for the FNA smears, and 88305 for a cell block that was prepared from the residual fluid?

A. The pathologist may bill separately for evaluation of each service. Report two units of 88305, Level IV-Surgical pathology, gross and microscopic examination, for the core biopsy and cell block. Use 88173, Cytopathology, evaluation of fine needle aspirate; interpretation and report, to report the pathologist’s interpretation and report on the FNA. Since the specimen was also decalcified, report 88311, Decalcification procedure (List separately in addition to code for surgical pathology examination), as well. Modifier 59 is not required to indicate that the services are independent of each other because there are no national correct coding initiative edits for these code sets.

Q: With codes 80500 and 80502, are we allowed to use a hospital standing order to comply with the Medicare requirement that the patient’s attending physician should request the clinical consultation?

A. Standing orders in the medical record do not satisfy the attending physician request requirement for clinical pathology consultation services reported with 80500, Clinical pathology consultation; limited, without review of patient’s history and medical records, or 80502, Clinical pathology consultation; comprehensive, for a complex diagnostic problem, with review of patient’s history and medical records, according to the Centers for Medicare and Medicaid Services.

Clinical consultations are payable under the Medicare Part B physician fee schedule only if they are requested by the patient’s attending physician; relate to a test result that lies outside the clinically significant normal or expected range in view of the condition of the patient; result in a written narrative report included in the patient’s medical record; and require that the consultant physician exercise medical judgment.

Codes 80500 and 80502 represent professional component only services and have no technical component value.

Frequently asked questions about CPT are published bimonthly in “Capitol Scan.” This section of CAP TODAY is a product of the CAP Economic Affairs Committee.

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.