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Pathology/Lab Coding Alert

Watch for 3 Complications When Coding Special Stains

- Published on Sun, Aug 28, 2005
Don't get tripped up on stain name

Each time you choose between 88312 and 88313, you have to remember the reason the pathologist ordered the stain - to identify micro-organisms or to diagnose other conditions.

What's in a name? Although CPT Codes provides specific stain names as examples in the code definitions, you have to choose the proper code(s) based on the stain's use. "The stain name and specimen type have far less impact on your selection of 88312 or 88313 than knowing whether the pathologist uses the stain to evaluate cell morphology or to confirm infectious agents," says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc., a pathology business-practices publishing company in Simpsonville, Ky. Steer Clear of Common Stain Mistakes Avoid pitfalls when you're reporting stains from one of the following groups:
   +88312 - Special stains (list separately in addition to code for primary service); Group I for microorganisms (e.g., Gridley, acid fast, methenamine silver), each
   +88313 - Special stains (list separately in addition to code for primary service); Group II, all other (e.g., iron, trichrome), except immunocytochemistry and
immunoperoxidase stains, each.   Follow these tips to overcome three common 88312/88313 coding snags: Snag 1. Stain Cocktail Yields Two Interpretations Labs often perform multiple individual stains on a single specimen and code separately for each one. But what should you do if the lab uses a "cocktail" of two stains mixed together?

Example: The lab mixes periodic acid-Schiff (PAS) and Alcian blue and uses this single reagent to stain esophageal biopsy specimens when medically indicated. The PAS stain can help detect and definitively identify organisms such as fungi. Pathologists use the Alcian blue stain to assess cellular distortions indicative of Barrett's esophagus, which is a chronic peptic ulcer of the esophagus.

If the pathologist examines a PAS/Alcian blue-stained biopsy for the presence of micro-organisms and to investigate Barrett's syndrome, report the professional component (modifier 26, Professional component) of both 88312 and 88313 for the "cocktail," just as you would if the pathologist examined slides stained separately with PAS and Alcian blue. "The physician work is fundamentally the same whether the stains are separate or mixed, and I think that's why the AMA OK'd reporting two codes in this instance," Padget says.

Sample report: Look at the following pathology report for an example of documentation that supports coding both stains:

Preoperative Diagnosis
Operative findings: 4 cm of columnar metaplasia; Barrett's esophagus; rule out fungal infection.

Specimens Submitted
Biopsy of esophagus.

Pathologic Diagnosis

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