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Avoid the 5-slide trap.

Here’s a code that baffles many new pathology coders, and maybe even some seasoned veterans: 88160 (Cytopathology, smears, any other source; screening and interpretation). Other? Other than what?

The answer lies outside the code definition itself, which is why it seems so cryptic to the uninitiated. And 88160 is not the only code with the “other source” conundrum, because 88160 is the parent code for two other codes, as follows:

• 88161 — …  preparation, screening and interpretation
• 88162 — … extended study involving over 5 slides and/or multiple stains.

Read on to let our experts solve the 88160-88162 mystery for you.

Coder tip: Remember that cytopathology, or cytology, refers to slides that contain cellular material but are not actual pieces of tissue. The cells are obtained from fluids or similar sources or by touching a collection device to tissue to collect some cells.

Focus on Cytopathology ‘Big Picture’

Codes 88160-88161 are a small oasis in the larger CPT® cytopathology section. Disregarding flow cytometry, fine needle aspiration (FNA) and fluorescence in situ hybridization (FISH), the section ranges from 88104-88175 and encompasses three main specimen types. The classification of the specimen types is the key to understanding “any other source” in the 88160-88162 code definitions.

Three specimen types: The following list shows the three types of cytology specimens and their related codes:

• Cervical or vaginal: Often called gynecological cytopathology, or Pap smears 88141-+88155, 88164-88167, and 88174-88175
• Except cervical or vaginal: Also known as “fluids, washings or brushings” 88104-88106, and sometimes 88108-88112
• Any other source: 88160-88162.

In that context, you can see that “any other source” means any cellular source other than cervical, vaginal, fluids, washings, or brushings. 

What does that leave? “Codes 88160-88162 primarily refer to directly smearing onto a slide a non-fluid such as sputum or nipple discharge, or preparing a slide from cells gathered by touching the surface of a tissue specimen,” explains Peggy Slagle, CPC, coding and compliance manager for the department of pathology/microbiology at the University of Nebraska Medical Center in Omaha.

Distinguish 88160, 88161, and 88162

Now that you know what specimens we’re talking about, you need to understand the distinction between the three codes in the 88160-88162 family.

88160: Use 88160 when the lab receives prepared slides of direct smears of specimens such as sputum or nipple discharge. 

88161: Reserve 88161 for slides that the lab prepares by touching the slide to the surface of a tissue specimen, often called “touch preps,” or for when the lab prepares the direct smear slides from specimens such as sputum.

Alert: Although 88161 describes touch preps, you shouldn’t use this code if the pathologist examines touch prep slides as part of an intraoperative consultation — you should turn to 88333 and +88334 (Pathology consultation during surgery; cytologic examination [e.g., touch prep, squash prep] …) in those cases. Also, Medicare and most other payers won’t cover 88161-family touch preps in addition to a surgical pathology examination (88302-88309) for the same specimen.

88162: Report 88162 if the pathologist evaluates more than five slides and/or different standard stains beyond the initial stain.

Caution: Use 88162 only if the specimen fits the ‘any other source’ description. Never use 88162 for cases involving cervical or vaginal smears, or fluids/washings/brushing specimens. 

“Code 88162 is even more of a mystery because, unlike the other codes in the family, the 88162 definition doesn’t state that the service includes interpretation,” points out William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore. However, Medicare assigns a technical and professional component to 88162 and prices it at about 1 ½ times the 88160 rate, indicating the expectation that the global code includes a physician interpretation. 

Leave 88160 Family for Non-Direct Smears

If the lab processes a specimen that qualifies as “any other source” but that uses methods other than a direct smear, you should leave the 88160 family in search of other codes.

For instance: Labs sometimes concentrate sputum specimens, often by processing in Saccomanno fluid, and you should report that service using 88108 (Cytopathology, concentration technique, smears and interpretation [e.g., Saccomanno technique]).  

Similarly, if the lab processes an “any other source” specimen using liquid-based cytology, often referred to as thin-layer preparation, you should leave the 88160 family and turn to 88112 (Cytopathology, selective cellular enhancement technique with interpretation [e.g., liquid based slide preparation method], except cervical or vaginal).