Summary & Overview
CPT 88312: Special Stain with Interpretation and Report, Group I
CPT code 88312 covers special stains, including interpretation and reporting, for Group I stains commonly used in pathology laboratories. This code is critical for the identification of microorganisms and tissue elements, such as those found in infectious diseases or certain malignancies, supporting precise clinical diagnosis. Nationally, the code is recognized by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, ensuring broad coverage for pathology services.
Readers will gain insight into the clinical context of 88312, including its role in laboratory diagnostics, typical sites of service, and the importance of both technical and professional components. The publication also provides benchmarks, policy updates, and an overview of related codes and modifiers, offering a comprehensive understanding of how this code fits into the broader landscape of pathology billing and reimbursement. Key ICD-10 diagnoses associated with 88312 include conditions such as tuberculosis, HIV disease, pneumonia, candidal stomatitis, and aspergillosis, highlighting its relevance in infectious disease diagnostics. The summary also addresses related CPT codes and taxonomies, equipping readers with essential information for navigating pathology billing and coding.
CPT Code Overview
CPT code 88312 is used to report special stains, including interpretation and report, for Group I stains such as Gridley and acid fast. This procedure is a part of Pathology and Laboratory Procedures, specifically performed in a laboratory setting. Both the technical and professional components are typically involved, reflecting the comprehensive nature of the service. Special stains are essential for identifying specific microorganisms or tissue elements, supporting accurate diagnosis and patient management.
Clinical & Coding Specifications
Clinical Context
A patient presents with respiratory symptoms and a lung biopsy is performed to investigate possible infectious or inflammatory disease. The specimen is sent to the laboratory, where a pathologist orders special stains such as Gridley or acid-fast stains to identify organisms like mycobacteria or fungi. The pathologist interprets the stained slides and issues a report detailing the findings. This workflow is typical for patients suspected of having conditions such as tuberculosis, HIV-related infections, pneumonia, candidiasis, or aspergillosis, where special stains are necessary to aid in diagnosis.
Coding Specifications
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Modifiers:
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26: Used when reporting only the professional component (interpretation and report) of the service. - Modifier
TC: Used when reporting only the technical component (preparation and staining of slides) of the service.
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Provider Taxonomies:
Taxonomy Code Specialty Name 207ZP0102X