Pathology/Lab Coding Alert

Question: I work for a molecular and cytogenetics lab, and we're wondering if 88367 and 88368 are only for surgical specimens since they're listed in the surgical pathology CPT section. If so, should we use cytogenetics codes for FISH on specimens such as blood?

Tennessee Subscriber

Answer: As a molecular cytogenetics lab, you would probably use codes from the range 88271-88275, although you should not distinguish fluorescent in situ hybridization (FISH) codes based solely on the specimen type (such as tissue versus blood). Rather, you should choose the code based on the testing context, according to the College of American Pathologists (CAP).

Select one of these codes for FISH tests the pathologist performs as an ancillary analysis to surgical pathology and cytopathology:

• 88365 -- In situ hybridization [e.g., FISH], each probe

• 88367 -- Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), each probe; using computer-assisted technology

• 88368 -- ... manual.

When the lab performs a FISH test as an ancillary analysis for cytogenetic studies, you should select one of these codes:

• 88271 -- Molecular cytogenetics; DNA probe, each (e.g., FISH)

• 88272 -- ... chromosomal in situ hybridization, analyze 3-5 cells (e.g., for derivatives and markers)

• 88273 ��" ... chromosomal in situ hybridization, analyze 10-30 cells (e.g., for microdeletions)

• 88274 -- ... interphase in situ hybridization, analyze 25-99 cells

• 88275 --... interphase in situ hybridization, analyze 100-300 cells.

CMS emphasizes physician service: In the National Correct Coding Initiative Policy Manual, CMS emphasizes that you should use 88365-88368 when a physician reads, quantitates, and interprets the tissues/cells stained with the probes and 88271-88275 when a non-physician, such as a laboratory scientist (PhD) or technician, performs the service. In practice, this distinction corresponds fairly well with the CAP distinction between the code sets.