How To Use CPT Code 88323

CPT 88323 describes the consultation and report on referred material requiring the preparation of slides by a qualified provider, typically a pathologist. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 88323?

CPT 88323 can be used to describe the consultation and report on referred material that requires the preparation of slides by a qualified provider, usually a pathologist. This code is used when a provider receives a consultation request and referred material, such as tissue or tissue blocks, and prepares slides with routine or special stains. The provider then evaluates the slides and provides a detailed report of their findings and opinion.

2. Official Description

The official description of CPT code 88323 is: ‘Consultation and report on referred material requiring preparation of slides.’

3. Procedure

1. A qualified provider, typically a pathologist, receives a consultation request and referred material, such as tissue or tissue blocks.
2. The provider prepares slides with routine or special stains.
3. The provider thoroughly examines the slides and evaluates the material.
4. A detailed report is prepared, documenting the provider’s evaluation and opinion.

4. Qualifying circumstances

CPT 88323 is used when a provider receives referred material, such as tissue or tissue blocks, for consultation and preparation of slides. The consultation request can come from another pathologist, surgeon, or clinician who wants the material analyzed or seeks a second opinion. It is important to note that the consultation does not occur during surgery but after an initial diagnosis has been made.

5. When to use CPT code 88323

CPT code 88323 should be used when a qualified provider, typically a pathologist, performs a consultation and prepares slides for referred material. This code is appropriate when the consultation request is for a surgical pathology or cytology case from an outside institution and the consultation occurs after the initial diagnosis has been made. It is important to review payer policies as some may limit the reporting of CPT 88323 to once per patient per day, even if the provider consults on multiple surgical cases.

6. Documentation requirements

To support a claim for CPT 88323, the provider must document the following information:

• The consultation request and the source of the referred material
• The preparation of slides with routine or special stains
• A thorough examination and evaluation of the slides
• A detailed report documenting the provider’s evaluation and opinion

7. Billing guidelines

When billing for CPT 88323, ensure that the provider performing the service is a qualified professional, typically a pathologist. It is important to follow payer policies regarding the reporting of this code, as some may have limitations on the number of times it can be reported per patient per day. Additionally, consider reporting guidelines for consultation during surgery (CPT 88329 to 88334) and review payer policies for any specific requirements or restrictions.

8. Historical information

CPT 88323 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A pathologist receives a consultation request for a tissue sample from an outside institution. The pathologist prepares slides with routine stains, examines them thoroughly, and provides a detailed report of their evaluation and opinion.
2. A surgeon seeks a second opinion on a tissue sample. The pathologist prepares slides with special stains, evaluates them, and prepares a comprehensive report with their findings and opinion.
3. A clinician requests a consultation on a cytology case. The pathologist prepares slides, examines them, and provides a detailed report documenting their evaluation and opinion.
4. A pathologist receives multiple tissue specimens from different body areas for consultation. The pathologist prepares slides, evaluates them, and prepares a single report summarizing their evaluation and opinion for all the specimens.
5. A pathologist receives a consultation request for a tissue block from an outside institution. The pathologist prepares slides with routine stains, examines them thoroughly, and provides a detailed report with their evaluation and opinion.
6. A surgeon requests a second opinion on a cytology case. The pathologist prepares slides with special stains, evaluates them, and prepares a comprehensive report documenting their evaluation and opinion.
7. A clinician seeks a consultation on a surgical pathology case. The pathologist prepares slides, examines them, and provides a detailed report summarizing their evaluation and opinion.
8. A pathologist receives referred material for consultation from an outside institution. The pathologist prepares slides with routine stains, evaluates them, and prepares a report detailing their evaluation and opinion.
9. A surgeon requests a second opinion on a surgical pathology case. The pathologist prepares slides with special stains, examines them, and provides a comprehensive report documenting their evaluation and opinion.
10. A clinician seeks a consultation on a cytology case. The pathologist prepares slides, evaluates them, and prepares a detailed report summarizing their evaluation and opinion.