Pathology/Lab Coding Alert

Question: If the pathologist receives two separately identified sentinel lymph nodes and we perform immunohistochemical staining on blocks from each node, how many stain units can we report?

Texas Subscriber  Answer: The unit of service for special stains is the specimen. Report the immunohistochemical (IHC) stain for each sentinel lymph node as 88342 (Immunocytochemistry [including tissue immunoperoxidase], each antibody). Because you have two specimens, you can report the special stain once for each sentinel lymph node. Even if you stain multiple slides from single or multiple blocks prepared from a single specimen, you should report only one stain code.
Notice, however, that 88342 states, each antibody. If the lab performs multiple antibody stains on each lymph node, you should report 88342 for each stain on each specimen. For example, you should report two sentinel lymph node biopsies, each with two separate IHC stains, as follows:
 
  2 x 88307 (Level V Surgical pathology, gross and microscopic examination, sentinel lymph node) for the pathologists examination of two sentinel nodes
  4 x 88342 for two IHC stains on each of two specimens.
 Some carriers require that you use modifier -59 (Distinct procedural service) when reporting multiple surgical pathology procedures for the same patient on the same day.   Reader Questions and You Be the Coder were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctors Anatomic Pathology Services in Jonesboro, Ark.