CPT Questions

August 2004

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 pathology.

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 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.