88360

[necruz]

We just now started to do the ER/PgR/Her2/Ki67 stains in house. Is it correct to bill 88360 x 4 (for each stain)? Is it also correct to bill the same stains again with the other immunohistochemical stains performed as 88342/88341? Please advise - Thanks

 

[rae3613]

It is correct to bill as 88360 if they are reported with quantitative or semiquantitative results. E.g. 'Ki67 labels 40 to 50 % of the tumor cells' If there are no quantitative results, then you will need to bill with 88342/88341.
I'm not sure I understand your second question. You wouldn't bill twice for the same IHC stains but you can bill it with other IHC stains billed with 88342/88341.

 

[necruz]

Thank you rae3613 - The report does have the quantitative results so we will bill 88360 x 4. Let me clarify my 2nd question - the report i am looking at involved only the Left Breast and it had other IHC stains (ex e-cadherin, p40, p63 and a few others) including the ER/PgR/Her2/Ki67 quantitative results. It has been brought up that the ER/PgR/Her2/Ki67 stains can also be billed as IHC stains and therefore we can also bill them as 88342/88341 stains. I disagree and i need clarification. Thanks

 

[rae3613]

Oh ok. 88360 is already billing for the IHC stains (with quantitative results). In the CPT under both 88360 and 88342/1 it states ‘Do not report 88342/1/88344 in conjunction with 88360 unless each procedure is for a different antibody.’
You cannot bill both 88360 and 88342 for the same IHC On the same specimen.

 

[danachock]

Hi necruz
I somewhat disagree that the ER/PR/HER2/Ki-67 can also be billed as IHC stains. Please let me explain.
If the ER and PR performed are quantitative (as stated above) - you will bill 88360. (Just so everyone knows the ER and PR can be performed as an IHC and not just quantification).
HER2 and Ki-67 are quantitative both being billed with 88360.
Ki-67 is quantitative even if the number is zero. It will state something like <0 (which is still a quantitative percentage; there however was nothing to find). Bill it 88360.
(HER2 is not IHC) - HER2 can be quantitative (88360); and if the test is "equivocal" a FISH "reflex" may be ordered billing 88377.
The other stains mentioned above - the E-cadherin you will bill with 88342 with XU modifier, p40 bill with 88341 with XU modifier, p63 bill with 88341 with XU modifier, and any other IHC stains performed bill with 88341 with XU modifier. Please make sure your pathologist's is stating why these tests are performed in either the microscopic area or the IHC table to "rule out, rule in, validate xxxxx, confirm xxxxx, etc..." if you are ever faced with a denial. These IHCs are used to differentiate on the kind of cancer the patient may have and any invasions. This is useful information for the treatment plan for the patient - lumpectomy, mastectomy, radiation, chemotherapy (what type/for how long). If we don't know exactly what type of cancer the patient has it becomes difficult to come up with an effective treatment plan for curative care.
Please reach out with any additional questions and have a great evening.
Thank you for listening,
Dana

 

[necruz]

Hi Dana -- You have been a tremendous help. I appreciate your feedback. In regards to the XU modifier, is that for all insurances (Commercial and Medicare) that it can be used on or only Medicare? Thank you.

 

[danachock]

Hi necruz
We follow Medicare guidelines where I work for all payors (commercial, Medicare, or otherwise). If 88360 is billing with 88342 or 88341 we will apply XU modifier to both 88342 and 88341 charges for every patient regardless of their health insurance. The XU modifier is more specific for this scenario.
Have a wonderful evening,
Dana

 

[necruz]

Thank you Dana. Have a great week.