How To Use CPT Code 88321

CPT 88321 refers to a consultation and report on referred slides prepared elsewhere, typically performed by a pathologist. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 88321.

1. What is CPT 88321?

CPT 88321 is a medical billing code used to describe a consultation and report on referred slides prepared elsewhere. This code is typically used when a qualified provider, such as a pathologist, is requested to review slides prepared at another location and provide their expert opinion in the form of a report.

2. 88321 CPT code description

The official description of CPT code 88321 is: “Consultation and report on referred slides prepared elsewhere.”

3. Procedure

1. A consultation request is received by the qualified provider, typically a pathologist, from another clinician or institution.
2. The provider reviews the prepared slides, which may include multiple slide types such as cytology or tissue slides from different body areas.
3. The provider examines the slides thoroughly and forms an evaluation and opinion based on their expertise.
4. A detailed report is prepared by the provider, outlining their findings and conclusions.
5. The report is sent back to the requesting clinician or institution for further action or consideration.

4. Qualifying circumstances

Eligibility for CPT code 88321 services is determined by the following criteria:

• The consultation request must be for a surgical pathology or cytology case from an outside institution.
• The consultation must not occur during surgery but later, following an initial diagnosis.
• The provider must be a qualified professional, such as a pathologist, with the appropriate expertise to review and evaluate the slides.

5. When to use CPT code 88321

It is appropriate to bill the 88321 CPT code when a qualified provider, such as a pathologist, is requested to review slides prepared elsewhere and provide a consultation and report on their findings. This code should be used for consultations that occur after an initial diagnosis and not during surgery.

6. Documentation requirements

To support a claim for CPT 88321, the following information must be documented:

• A detailed consultation request from the referring clinician or institution, specifying the need for a surgical pathology or cytology case review.
• A thorough examination of the slides by the qualified provider, including any relevant findings and conclusions.
• A comprehensive report prepared by the provider, outlining their evaluation and opinion on the case.
• Any additional communication or follow-up actions taken by the provider in relation to the consultation.

7. Billing guidelines

When billing for CPT code 88321, it is important to follow these guidelines:

• Ensure that the consultation request is for a surgical pathology or cytology case from an outside institution.
• Confirm that the consultation does not occur during surgery but later, following an initial diagnosis.
• Be aware that the surgical case, not the specimen, is the unit of service for 88321. However, check payer policies before reporting this code, as some payers may limit you to reporting 88321 once per patient per day even when the provider consults on more than one surgical case.

8. Historical information

CPT 88321 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 88321

Five similar codes to CPT 88321 and how they differ are:

• CPT 88323: This code is used for a consultation and report on referred material requiring preparation of slides, which includes the additional step of slide preparation.
• CPT 88325: This code is for a consultation, including a comprehensive review of records, specimens, and other data, as well as a written report.
• CPT 88329: This code is used for a pathology consultation during surgery, which differs from 88321 as it occurs during the surgical procedure.
• CPT 88331: This code is for a consultation and report on referred materials requiring a rapid diagnosis during surgery, which is a more urgent and time-sensitive consultation.
• CPT 88334: This code is for a consultation and report on referred materials requiring a rapid diagnosis during surgery, with each additional tissue block.

10. Examples

Here are 10 detailed examples of CPT code 88321 procedures:

1. A pathologist reviews slides of a breast biopsy prepared at another institution and provides a consultation and report on their findings.
2. A dermatopathologist evaluates slides of a skin lesion prepared elsewhere and offers their expert opinion in a detailed report.
3. A hematopathologist examines slides of a bone marrow biopsy prepared at a different facility and provides a consultation and report on the case.
4. A neuropathologist reviews slides of a brain tumor biopsy prepared at another hospital and offers their expert opinion in a written report.
5. A cytopathologist evaluates slides of a fine needle aspiration of a thyroid nodule prepared elsewhere and provides a consultation and report on their findings.
6. A pathologist examines slides of a lung biopsy prepared at a different institution and offers their expert opinion in a detailed report.
7. A gastrointestinal pathologist reviews slides of a colon biopsy prepared elsewhere and provides a consultation and report on the case.
8. A pathologist evaluates slides of a liver biopsy prepared at another facility and offers their expert opinion in a written report.
9. A pathologist examines slides of a kidney biopsy prepared at a different hospital and provides a consultation and report on their findings.
10. A pathologist reviews slides of a lymph node biopsy prepared elsewhere and offers their expert opinion in a detailed report.