Your CPT Questions

July 2006

Q: We receive cervical biopsies along with an endocervical curettage, which is a brushing of the endocervix without tissue that is submitted in CytoLyt solution. We process the endocervical brushing specimen as ThinPrep slides, but these are not considered Pap smears. Can we bill this as a nongynecologic specimen even though it is a cytology of a gynecological site?

A. The correct code for reporting an endocervical brushing submitted in CytoLyt solution and processed using a ThinPrep processor is CPT code 88112, Cytopathology, selective cellular enhancement technique with interpretation (eg, liquid based slide preparation method), except cervical or vaginal. This diagnostic code is most appropriate because it denotes both the special technical preparation and interpretation necessary for an endocervical brushing with ThinPrep slide preparation.

If a cell block only is prepared, use CPT code 88305. If a cellular enhancement preparation and cell block are prepared, use CPT codes 88112 and 88305. Alternatively, this specimen may be processed as cytocentrifugation preparations and coded as 88108 with or without a cell block.

Q: When our laboratory sends out surgical pathology slides for expert consultation, it covers the charges unless the patient has specifically requested a second opinion. Our understanding has been that if a pathologist requests the consultation, it is the responsibility of the lab to cover the cost of the consultation. However, a staff member from one of our consulting laboratories recently informed one of our employees that we could pass along consultation charges to the patient or patient’s insurance. Is this true?

A. In an ideal situation, the patient is informed of the diagnostic challenge and the value of the slides being sent to an expert. In such circumstances, it is appropriate to bill the patient or patient’s insurance for the service. When the pathologist thinks it is in the patient’s best interest to get a consultation, the clinician/surgeon should be part of the discussion of the patient’s slides and the need for expert consultation. In those circumstances, it is appropriate to bill the patient or patient’s insurance. If the pathologist is seeking the consultation for internal quality assurance/quality control reasons, the patient should not be charged.

It is good patient care for all anatomic pathology labs and hospitals to have a budget for such situations and for the patient who cannot afford but needs an expert opinion. The designated budget would represent a small fraction of the amount of resources spent each day in the lab for such activities as chemistry QA/QC.

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.