Major changes compared to CPT-2011 related to pathology billing appear in red font, with deletions designated via double strike-out (e.g., deletion) are listed below.

 ***One item of special note is that beginning in January purportedly, you will be able to bill for one unit of special stain per surgical block or cytologic specimen***.

The principal changes in CPT-2012 compared to CPT-2011 are (1) new Tier 1 and Tier 2 molecular pathology codes and instructions; (2) cytology code 88107 has been deleted; and (3) the descriptors and instructions for special stain codes 88312-88319 have been modified. Note that special stain code 88318 has been deleted. Note also that the AMA now advises that the unit of service for special stains focuses on the block, which comports with Medicare policy. Publication in CPT-2012 of the new Tier 1 and Tier 2 molecular pathology codes may be a moot point. Although a last minute change in position cannot be ruled out, CMS has basically already said that it will not recognize any but the stacking codes (83890-83914) for molecular pathology before 2013 at the earliest. Private insurers likely will follow Medicare’s lead in these regards, but that too is uncertain at the moment. We’ll keep you posted on news from Medicare regarding possible use of the new molecular pathology codes in 2012. These changes can be found here for those clients who will be affected.

Anatomic Pathology 2012 CPT Changes 

***Wording changes to existing CPT codes are listed in red font except on CPT code 88177 where term “evaluation episode from 2011 changes is being reiterated in this notice. *** 

38230 Bone marrow harvesting for transplantation, allogeneic 

38232 autologous           

88107 smears and simple filter preparation with interpretation (Do not report 88106 in conjunction with 88104) (88107 has been deleted. To report smears and simple filter preparation, see 88104, 88106)

 88172 Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, first evaluation episode, each site

(The “evaluation episode” represents a complete set of cytologic material submitted for evaluation and is independent of the number of needle passes or slides prepared. A separate evaluation episode occurs if the proceduralist provider obtains additional material from the same site based on the prior immediate adequacy assessment, or a separate lesion is aspirated)

88173 interpretation and report 

88177 immediate cytohistologic study to determine adequacy for diagnosis, each separate additional evaluation episode, same site (List separately in addition to code for primary procedure)(When repeat immediate evaluation episodes(s) is required on subsequent cytologic material from the same site, e.g., following determination the prior sampling that was not adequate for diagnosis, use 1 unit of 88177 for each additional “evaluation episode”) (Use 88177 in conjunction with 88172) 

(For cell enumeration using immunologic selection and identification in fluid specimen [e.g., circulating tumor cells in blood], see 0279T, 0280T)

88312 Special stains including interpretation and report; Group I for microorganisms (e.g., Gridley, acid fast, methenamine silver), including interpretation and report

 *** (Report one unit of 88312 for each special stain, on each surgical pathology block, cytologic specimen, or hematologic smear) *** 

88313 Group II, all other (e.g., iron, trichrome), except stain for microorganisms, stains for enzyme constituents, or immunocytochemistry and immunoperoxidase stains, including interpretation and report, each 

**** (Report one unit of 88313 for each special stain, on each surgical pathology block, cytologic specimen, or hematologic smear) ****

88314 histochemical stain on frozen tissue block staining with frozen section(s), staining with frozen section(s) including interpretation and report (List separately in addition to code for primary procedure) (Use 88314 in conjunction with 17311-17315, 88302-88309, 88331, 88332) (Do not report 88314 with 17311-17315 for routine frozen section stain [e.g. hematoxylin and eosin, toluidine blue], performed during Mohs surgery. When a nonroutine histochemical stain on frozen tissue during Mohs surgery is utilized, report 88314 with modifier 59.) (Report one unit of 88314 for each special stain on each frozen surgical pathology block) (For a special stain performed on frozen tissue section material to identify enzyme constituents, use 88319)

(88318 has been deleted) (For determinative histochemistry to identify chemical components, use 88313)88318 Determinative histochemistry to identify chemical components (e.g., copper, zinc) 

88319 Group III, Determinative histochemistry or cytochemistry to identify for enzyme constituents, each  (For each stain on each surgical pathology block, cytologic specimen, or hematologic smear, use one unit of 88319) (For detection of enzyme constituents by immunohistochemical or immunocytochemical technique, use 88342)