Notes/references:  ( ***items without a technical component chargeable by the facility)

1. Many years ago, we discovered that we could eliminate the need for repeat procedures if (a) we were always on standby (deep FNAs need not be scheduled during usual hours...our constant availability reduces stress on the radiologist team) and (b) if the pathologist was in the operative room and (c) helped the biopsying doctor with the procedure and, by having exact case information and differential diagnosis information (multidisciplinary discussion and imaging review), (d) consulted on both the types (need for cores , culture, etc.) and adequacy of the specimens. By being there, the pathologist has the opportunity to view the fresh aspirate color and consistency and discern whether to save for culture and whether adequate sample has been obtained...and, depending on the riskiness of the target location and the details of the differential diagnosis, to interpret when to ask for more specimen or when to stop. We used 88329 because there was no other suitable code. But, in a coding audit May 2006, we were told that there is no compensation code for this valuable and that we'd just have to quit doing the work or do it without a specific fee.
2. If referred patients are electively scheduled for one of our pathologists to do a superficial FNA, we are usually able to operate at the convenience of the patient. And, we make a microscopic assessment prior to the patient leaving (qualifying for an 88172 charge). We promptly respond to radiation oncology and other services for pathologist-performed superficial FNAs in the hospital.
3. Leslie Narramore of CAP (e-mail 22 March 2002), referring to a CAP web file written about 1999, indicates that this code 88172 is able to be filed for each fine needle aspirate on which the operator asks the pathologist for a determination of adequacy (determination implies more than a strong naked-eye consultative opinion...implying the equivalent of a FS Dx, that is, an opinion based on rapid microscopic exam). It is also implicit that the operator will base the decision to terminate the procedure (or obtain another specimen) on that diagnosis.
4. Markers often give both organ-specific diagnostic and therapeutic information...way beyond what is possible by routine H&E...usually requiring a core biopsy specimen.
5. Cores generally obtain enough tumor for both marker-stain evaluation and appreciation of the tumor's microscopic pattern (not so with aspirate smears and usually not so with cell blocks, alone).
6. Some reference labs provide prepaid express shipping. We have to handle the case materials clerically, and the pathologist usually has to carefully review slides and blocks to pick the best sample for the reference test. But we don't charge for such handling. We use the reference labs for markers which are either very difficult or unusual. That is, nothing is sent for a reference lab marker which is not medically necessary.
7. Dennis I. Padget, 2 May 2002 CME in Pittsburgh (Padget & Associates, 501 Noland Rd., Simpsonville, KY 40067, 502-722-8873.
8. Beth McDevitt, PSA Coding and Compliance, various telephone conversations and e-mails, Jan 2002-present.
9. The Armed Forces Institute of Pathology and The Mayo Clinic will not bill patients for consults; so, our group or Lexington Medical Center would cover the charge and then bill the patient.
10. Today's Health, Fall 2002, Quantum Business Service, Coding Q&A by Dennis Padget (noting an official response from AMA CPT Information Services)
11. Pathology/Lab Coding Alert 3(12):95-96, Dec 2002

(posted 10 September 2002; latest additions 14 June 2006)