Thank you so much Dana. That's what I thought. If there isn't a percentage or a value, then 88360 is not appropriate. I'm struggling in this area. Can you look at the codes below and verify which set is correct for the above scenario? There is a discrepancy between what I coded and what another person coded: (88305 X 2, 88342 X 2, 88341 X 8) vs (88305 X 2, 88342 X 2, 88341 X 6, 88360 X 2 )or (88305 X 2, 88342 X 2, 88360 X 6)?Hello and Good Evening sdaniels;
You brought up a very great immunohistochemical coding point today.
May I break it down in the terms that I code?
There are two primary immunohistochemical stains (those that are qualitative and those that are quantitative) "clearly" among others here. The focus this evening is on just these two scenarios okay.
88342 is primary procedure with 88341 the add on - those are qualitative. The pathologist applied an immunohistochemical stain and it is either "positive or negative".
I am reviewing your example - positive for Mammoglobin, AE1/AE3, ER, PR and are negative for HER2. There is only positive and negative discussed here. It is 88342/88341. No one has quantified anything.
No worries let's review 88360 (I look at my CPT book all the time that the majority of my pathology pages have been ripped out). Let us review 88360. It states in our CPT book that it is "morphometric analysis, tumor immunohistochemistry (eg, Her2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen each single antibody stain procedure, manual. It has to be presented quantitative; a numerical number like a percentage or value or otherwise (a quantitative number has to be provided). If someone (pathologist's) states that it is "low" that is not sufficient to bill 88360 CPT assignment here. Again; quantification is the rule of thumb. If you are billing 88342 with 88360 you are probably appealing it all; may want to be sure you have it documented to receive the entitled reimbursement (RVUS).
I hope this helps shed light on your coding woes, please reach out if you need additional assistance.
Dana
Hi Dana, I can't thank you enough for your help with this one. I was right! I hope it's okay if I contact you in the future, should I have any other difficult cases. Thank you! I appreciate your thorough explanation!Hello sdaniels,
Again, I will try to assist you. From the final interpretation without seeing the gross or microscopic I cannot clearly tell the difference between 88305 or 88307. I'd like to pretend it is a punch skin biopsy, but I really do not know reviewing the information provided. The gross and microscopic (with no PHI would assist). The reason(s) why I state this is because ~ let's review specimen A & B together with this information.
Were these skin biopsies, or breast lesions with margins reviewed?
A) states within the final interpretation that "patient's history of breast carcinoma, extending to peripheral margin"
B) states within the final interpretation that "patient's history of breast carcinoma, extending to peripheral & deep margins"
Next let's discuss the immunohistochemical stains:
Specimen A:
Mammoglobin, AE1/AE3, ER, PR, HER2 were either positive or negative (no quantification provided)
Specimen B:
Mammoglobin, AE1/AE3, ER, PR, HER2 were either positive or negative (no quantification provided)
Coding stains can be horribly cumbersome sometimes, so I'll walk you through this.
Specimen A: You bill 88342x1 for the Mammogloblin, 88341x4 (for the AE1/AE3, ER, PR, HER2)
Specimen B: You bill 88342x1 for the Mammogloblin, 88341x4 (for the AE1/AE3, ER, PR, HER2)
Let me summarize:
If this was a skin for example punch biopsy from two different sites we would bill at the end of the day
88305x2
88342x2
88341x8
If this was deemed a breast lesion with margins reviewed (not shared so unsure here???)
88307x2
88342x2
88341x8
Again, let me reiterate what I know. If the immunohistochemical stain is postive or negative (it is a qualitative stain). The first charge is billed with 88342 with subsequent charges billed with 88341.
If someone felt that 88360 (from your example above) was warranted to be billed it CLEARLY should have been displayed within the pathology report in a quantitative state (%, numerical, or otherwise here).
There is absolutely no way to support 88360 with a positive or negative finding unless you have THAT NECESSARY QUANTIFICATION. (If it was the pathologist's questioning ~do not be shy, many are so incredibly kind, just explain that you need a quantitative state to capture RVU's for getting CPT 88360 if you possibly felt they missed that opportunity.
Most do not know. Our pathologist's work super hard, and long. If I recall correctly from one of my pathologist mentors during their 8 years of training, they get that one "class in school". It clearly in my logistics isn't enough. It is a constant open communication line here from me. Since 2012 to now I still appreciate the opportunity to discuss new pathology trends
I am going to give a shout out to all those billers that appeal these scenarios. This is again the stuff that keeps me up at night and absolutely applaud every single one of you!!
The CCI edits are flooding appeals FOR ALL PAYORS because 88342, 88341 doesn't play well with 88360. Some billers have been there for so long and have taken the authority to "just" write stuff off if it is small enough and no one cares. I had so many denials that 88342 was denied because of 88360 so they wrote off the 88342 (small dollar amount I am guessing??) and now I had to deal with the other copious amounts of 88341 charges that were denied. I can provide fictious examples of this of course.
I apologize for being lengthy,
Please reach out to me if you have any questions.
Or PM me, if necessary, okay
Dana
You are very welcome, Stacey ~Hi Dana, I can't thank you enough for your help with this one. I was right! I hope it's okay if I contact you in the future, should I have any other difficult cases. Thank you! I appreciate your thorough explanation!
Thanks again, Stacey
Thank you so much! I agree! Merry Christmas and Happy New Year!Hello sdaniels
No, there is nothing from your post that has additional immunohistochemical stains. Your post only discusses SOX-10 with PRAME warranting 88342x1, 88341x1.
Goodness: that may be a great question to pose to your pathologists though. The reason I simply state that is because I have pathologist's that use "melanoma markers" that contain "Melan-A, HMB-45, with SOX-10" and by chance what if one was in error omitted here? Pathologists are super busy. Be the radar. From my review it was two stains 88342 with 88341x1 but what if something was missing, right?
You stated to review the melanoma profile; there is nothing there to even bill an immunohistochemical stain. It was all within their final interpretation.
Every pathologist's documents differently. That is not a coders problem. That is a facility problem not having auto fill or smart text's or auto fill in information readily available to make things uniform. Uniform isn't a new concept here. I'm all about RVUs for my pathologist's but tell me where you want me to focus my coding attention to. You state melanoma profile; that doesn't contain one stain. Not ideal for RVU's here.
I'm hopeful I provided some feedback here.
Not exactly had planned but I'm not one to sugar coat something when something seems amiss here.
Dana
Thank you, Dana! You have been so helpful! I actually missed this one originally, so I'm glad there is such a thing as charge correction! Thanks again!sdaniels ~ you nailed it! you have the coding spot on!
If anyone else was wondering why I state that.
First, Let's look at the body of pathology report. We all know AE1/AE3, GATA3, ER, PR and HER2 were performed.
Seriously, look at the rest of the pathology report to support those charges. THOSE ARE RVU'S to our pathologist's.
Before any coder removes a charge; did you exhaustively review the pathology report?
If you work in my field. Did you review documentation and actually take the time to scroll through the ENTIRE rest of it?
I do not normally sugar coat stuff, but this pathology coding scenario makes me believe I need to be here.
You NEED TO SCROLL POLITILEY TO THE BOTTOM TO CAPTURE THE 88360. The Biomarkers Profile area.
If you don't understand Morphometric just please tell me so.
I am hopeful that I was helpful, I am a little unsure why my text is in bold but if displayed, apologize now.
Just be certain each of the 4 stains in question also state “manual morphometry” within the report to support billing 88360’s. A numerical value is not enough to support 88360 as ER, PR, and Ki67 can also all be read by image analysis!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
Be sure that it stays “manual morphometry” within the report somewhere as well. Otherwise your 88360 charge is not supported! A numerical value alone is not enough to support the charge, you must have the method documented as well!Hi Dana,
I'm back with another question. Would this be 88305, 88342 (AE1/AE3), 88341 (GATA3) and 88360 X 3 ER,PR, Her2)?View attachment 7015
Hello Narobo,Just be certain each of the 4 stains in question also state “manual morphometry” within the report to support billing 88360’s. A numerical value is not enough to support 88360 as ER, PR, and Ki67 can also all be read by image analysis!
I agree with you that a numerical value does warrant an 88360 OR and 88361. However, the method that you use to read/interpret these stains (manual vs computer-assisted) also needs to be documented within the pathology report to support the charge. This is listed in the APF handbook under the 88360/88361 portion in section 6. You can definitely always come back and appeal a denial, but if you have the information at hand with how the stain was interpreted, all the better to add that to the report ahead of time so you are less likely to be met with a denial.Hello Narobo,
I will bill 88360 if tumor cells were quantified. I will appeal charges all day long. You need the numerical value %, <, >, or = to 1, 2, 3 with the disclaimer (key) on why; or possibly greater than 90%, 80%, 20% or otherwise to support billing this. It has to be quantified and I feel that I fully understand the pathology report to explain to the denial and billing team what needs to be done here to appeal this. Majority of the denials I worked at was supporting billing 88342 with 88341 with 88360.
Thank you for the insight and have a wonderful evening,
Dana