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Pathology/Lab Coding Alert

Reader Question:

Check Payer Rules for IHC

Published on Mon Apr 09, 2012

Question: Our lab processed a lymph node biopsy for a patient with melanoma. We stained blocks A-E with Mart-1, and blocks A-C with Ki67. Should we bill 88342 x 8 or 88342 x 2? California SubscriberAnswer: The answer may depend on your payer, but 88342 (Immunohistochemistry [including tissue immunoperoxidase], each antibody) x 2 is the correct way to bill Medicare for this service.Although for a time, Medicare and other insurers allowed billing immunohistochemistry (IHC) stains per block, a change to the NCCI Policy Manual effective Jan. 1, 2012 bans the practice. Medicare's correct coding initiative (CCI) instruction states, "The unit of service for immunohistochemistry (CPT codes 88342, 88360, 88361) is each antibody(s) stain (procedure) per specimen. If a single immunohistochemical stain (procedure) for one or more antibodies is performed on multiple blocks from a surgical specimen, multiple slides from a cytologic specimen, or multiple slides from a hematologic specimen, only [...]
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