Pathology/Lab Coding Alert

Question: How should we bill for tests on old specimens? Some of our physicians have been ordering tests such as HER-2/neu on tumor tissue taken up to six years ago. Colorado Subscriber Answer: Other than creating an internal system for tracking and identifying the specimen, billing for a new procedure on an old specimen should not be a problem. Just as any additional procedures like special stains are separately billable with the initial tissue evaluation, so a HER-2/neu test is separately billable, whether it occurs at the time of surgery or years later. Some labs are handling the internal tracking by creating a new specimen number for the HER-2/neu tests and making an addendum to the original report referencing the new number.

As to which codes to report for the HER-2/neu test, that depends on what procedure the lab is doing. Assessment of HER-2/neu protein overexpression through tissue immuno-histochemistry (IHC) staining is reported as 88342 (Immuno-cytochemistry [including tissue immunoperoxidase], each antibody). This code describes commercial IHC tests such as HercepTest by DAKO and Pathway by Ventana Medical Systems, as well as in-house IHC testing. On the other hand, assessment of HER-2/neu gene amplification by fluorescence in situ hybridization (FISH) is described by 88271 (Molecular cytogenetics; DNA probe, each [e.g., FISH]). The analysis of the hybridized DNA using the fluorescence microscope is reported as 88274 (Molecular cytogenetics; interphase in situ hybridization, analyze 25-99 cells). The pathologist's interpretation and report on the FISH study is reported as 88365 (Tissue in situ hybridization, interpretation and report).