Pathology/Lab Coding Alert

Question: We occasionally carry out two different immunohistochemistry procedures for sentinel lymph node evaluation and want to know if we can report both services. If a surgeon specifically requests an intraop-erative diagnosis to direct the extent of breast excision, we may perform a manual, low-molecular-weight cytokeratin on a sentinel-node touch prep and report the result directly to the surgeon while the patient is still in surgery. The next day, we conduct an automated immunohistochemistry using a different clone on paraffin sections of the sentinel node. Can we bill for each immunohistochemistry since the method is different (manual versus automated) and the cytokeratin antibodies are different clones? Florida Subscriber Answer: Although performing an immunocyto-chemistry on both the touch prep and tissue blocks from a sentinel lymph node is rare, if the service is rendered and supports medical necessity, you can separately report each procedure. List two units of 88342 (Immunocytochemistry [including tissue immunoperoxidase], each antibody) because the two tests represent different cytokeratin stains carried out on two different specimens the touch prep and the sentinel lymph node.

For proper payment, you must capture each individual service provided in this scenario. Report the touch prep as 88161 (Cytopathology, smears, any other source; preparation, screening and interpretation) and the intraop-erative pathology consultation as 88329 (Pathology consultation during surgery). The cytokeratin stain for the touch prep is 88342. The sentinel lymph node examination is 88307 (Level V Surgical pathology, gross and microscopic examination, sentinel lymph node). Report the automated immunohistochemistry on the sentinel node as one unit of 88342 regardless of the number of blocks or slides prepared from the specimen.