subject: 88333, +88334 Use Depends on Site/Specimen Distinction [print this page] 88333, +88334 Use Depends on Site/Specimen Distinction
Here's a pathology coding scenario that you might encounter while going about your work.
Scenario: "Our pathologist performed two intraoperative touch preps. The first on specimen A, left sentinel lymph node while the other on specimen B, a second left sentinel lymph node. We billed but the payer denied the charge as the lymph nodes are from the 'same lymph node basin.' Is the proper coding 88333 and 88334?
Well, you were right the first time. You should appeal the denial as proper coding for the case is 88333 (Pathology consultation during surgery; cytologic examination [example, touch prep, squash prep], initial site) for specimen A and 88333 for specimen B.
"Initial Site" in the 88333 code definition refers to the first touch prep from a single specimen. If the pathologist examines other touch preps from distinct sites on the same specimen, you should report each subsequent touch prep as +88334 (cytologic examination [example, touch prep, squash prep], each additional site [list separately in addition to code for primary procedure]).
Documentation counts: Ensure your documentation identifies two, unique specimens as you started in your question. Based on the payer's comment that the lymph nodes are from the same lymph node basin," it is possible that the payer thinks this is a regional lymph node resection.
You may also ask the payer if they need a modifier in the case of distinct specimens. Some payers will not accept billing units, but may want you to list the additional specimen with modifier 59 (distinct procedural service or 76 (Repeat procedure or service by the same physician or other qualified health care professional).
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