Surgical/cytology service versus clinical cytogenetics distinguishes codes
With two sets of codes that describe in situ hybridization (ISH), you have to know when to use each group. Changes in CPT Codes 2005 clarify that you should now use 88365 for adjunct ISH tests for surgical or cytopathology cases, not only for tissue specimens.
Before CPT 2005 removed the word "tissue" from 88365 (In situ hybridization [e.g., FISH], each probe), experts recommended that you report 88365 for tissue specimens - like a breast biopsy for Her-2/neu - and report molecular cytogenetics codes (88271, Molecular cytogenetics; DNA probe, each [e.g., FISH], through 88275) for nontissue ISH - like urine cytology, for recurring bladder cancer.
But removing "tissue" from the 88365 definition leaves us scrambling for a new dividing line. "The context of the study - not the specimen - separates the two code series today. You should distinguish the two sets of codes based on whether the ISH test is an adjunct to a surgical or cytopathology case, versus part of a clinical, chromosomal analysis," says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc., a pathology business publishing company in Simpsonville, Ky. ISH With Surgical/CytoPathology Cases Use codes 88365, 88367 (Morphometric analysis, in situ hybridization [quantitative or semi-quantitative], each probe; using computer-assisted technology) and 88368 ( ... manual) for surgical and cytopathology adjunct testing.
"The tests detect nonchromosomal specific DNA and RNA sequences using fluorescent, enzyme or other labels on DNA or RNA ISH probes," says Donald Cohen, MD, former member of the College of American Pathologists (CAP) Economic Affairs Committee and pathologist with Sharon Regional Health System in Sharon, Pa.
The 88365-88368 ISH tests help the pathologist visualize and localize a wide variety of cellular constituents including infectious agents (such as HPV, EBV), or define clonality in B-lymphocytes, Cohen says.
Pathologists also use ISH to define cell proliferation rates (such as histone H3) or to localize hormones in specific tissue cells (such as proinsulin), Cohen says. "All of these methods maintain essential cellular and tissue morphologic details for correlation and diagnosis, manually or by computer-assisted technology," he says.
Don't miss: CMS and CAP published instructions for 88365-88368 that support using these codes for pathologist tissue and cellular ISH services. "[Codes] 88365-88368 are intended to be used when performed as an ancillary analysis to surgical pathology and cytopathology services," according to the December 2004 CAP Today.
Similarly, CMS advocates using codes 88365-88368 for ISH services "when performed by a physician" (NCCI Policy Manual, version 10.3, available on the Internet at
www.cms.hhs.gov/physicians/cciedits/chap10.pdf). "Although the instruction [...]
