Think You're Coding FISH Procedures Correctly? Not if You Aren't Following These Rules
Published on Tue Sep 23, 2003
Experts explain tissue versus nontissue guidelines If you've been waiting for direction on how to code fluorescence in situ hybridization (FISH) procedures, the answers are here. At last, key authoritative sources offer clear advice on when and how to use molecular cytogenetics codes (88271-88275) or surgical pathology code 88365 for in situ hybridization testing. Even as FISH testing has become a clear diagnostic choice for certain breast and bladder cancers, coding for the procedure has become murkier. "No matter what source you consult - probe vendor, national reference lab, or well-respected trade publication - you find different FISH coding advice," says Dennis Padget, MBA, CPA, FHFMA, president of Padget & Associates, a pathology financial and compliance consulting firm in Simpsonville, Ky. But according to Padget, recent direction from authoritative sources - AMA, College of American Pathologists (CAP) and CMS - points to a coding consensus. Use Molecular Cytogenetics Codes for Nontissue Samples Use CPT codes 88271-88275 (Molecular cytogenetics; ...) and 88291 (Cytoge-netics and molecular cytogenetics, interpretation and report) to report each step of in situ hybridization based on which methods the lab uses. (For complete CPT code descriptions, see "Know Your FISH and Related Diagnostic Test CPT Codes and Uses" on page 75.) Even though these codes do not specify the sample source, coding authorities limit their use to cell samples from fluids and smears (disassociated or exfoliated cells) - not tissue samples from histologic processing. CMS states in program memorandum AB-99-84 that "88272-88275 ... are for molecular cytogenetic tests other than those performed on histologic sections."
"Although it appears the AMA initially intended codes 88271-88275 to accurately report FISH from any source, stating that forerunner codes 83896 [Molecular diagnostics; nucleic acid probe, each] and 88365 did not provide an accurate description of FISH, more recent AMA direction restricts their use to nonhistologic samples," Padget says.
The June 2002 CPT Assistant agrees that you should use these codes for cells, not tissue, stating, "The cytogenetics studies series of codes [88271-88275] describes the study of cells performed in a clinical laboratory." You should report 88291 for the physician interpretation of an entire patient study, according to the AMA. CAP has also weighed in on the issue, stating in the April 2002 issue of CAP Today, "The molecular cytogenetics codes should be reported when in situ hybridization is performed as a clinical laboratory study." Clinical laboratory studies involve samples such as urine and peripheral blood, not tissue specimens examined by a physician and reported using surgical pathology codes. Use Surgical pathology Codes for Tissue FISH Studies The three sources - AMA, CMS and CAP - also agree that you should report tissue FISH studies [...]
