Pathology/Lab Coding Alert

Lab method and results determine your code selection

CPT 2005 changes the way you report tissue immunohistochemistry (IHC) exams. But you can always choose the right code - 88342, 88360, or 88361 - as long as you know whether the test is qualitative or quantitative/semiquantitative, and whether the procedure is manual or automated.

The code changes also clear up some previous problems, like how to overcome National Correct Coding Initiative (NCCI) edits that had stopped your lab from capturing certain quantitative/semiquantitative IHC services.

Use the following four tips to help you select the appropriate IHC code every time: 1. Decide Whether the Test Is Qualitative Only one code describes a qualitative tissue IHC stain-CPT 88342  (Immunohistochemistry [including tissue immunoperoxidase], each antibody). Pathologists use these qualitative antibody stains as "markers" for the presence or absence of specific antigens used to identify tumor type. "The pathologist interprets these stains as 'yes,' the antigen is present, or 'no,' the antigen is not present, or may qualify based on stain intensity, without any quantification regarding the degree of staining," says Joan Logue, BS, MT-ASCP, principal with Health Systems Concepts Inc. in Longwood, Fla.

Don't overlook: The code definition states "each antibody," so you should report one unit of 88342 for each antibody stain that the pathologist examines for a specific tissue specimen. "It's not unusual for a pathologist to evaluate a series of IHC antibody stains to assist in tumor typing, and you should list each stain as one unit of 88342," Logue says.

On the flip side, don't report multiple units of 88342 for a single type of antibody stain on a single tissue specimen - even if the pathologist examines multiple slides. "A sentinel lymph node biopsy might include multiple cytokeratin-stained slides taken from various levels of the excised tissue, but the exam only involves one antibody," Logue says. You should report this service as 88307 (Level V - Surgical pathology, gross and microscopic examination, sentinel lymph node), plus 88342 for the multiple cytokeratin stains.

Lesson: Only use 88342 to describe a qualitative test, such as an estrogen receptor/progesterone receptor (ER/PR) stain that the pathologist examines to identify the presence or absence of ER/PR in a breast tissue biopsy.

If the pathologist provides a quantitative/semiquantitative ER/PR evaluation, don't use 88342. CPT 2005 revised the text note following 88342 to direct coders, "For quantitative or semiquantitative IHC, see 88360 or 88361." That's why you need to study Tip 2: 2. Document the Test as Quantitative or Semiquantitative CPT 2005 added new code 88360. Now you have to choose between two codes that describe morphometric analysis of IHC - stained slides with a quantitative or semiquantitative result:

 88360 - Morphometric analysis, tumor immunohistochemistry (e.g., Her-2/neu, estrogen receptor/progesterone [...]