Wiki Coding 88342 more than once same stain same spec.

[janeefox]

I have a client that wants me to code 88342 more than once on the same specimen and it is the same stain. Here is what she is wanting...
I had called you because the CMS has published new unit of service rules for special stains, including 88342 and 88360 effective 10/01/09, as you see, the unit of service for special stains will be the BLOCK, not the SPECIMEN, so we can bill per stained BLOCK. For example, cytokeratin on 4 blocks would be 88342x4 not 1. I had asked you to look at Chapter 10 Version 15.3 NCCL manual, which you responded below. I disagree. I am copying page 15 of the manual below. Please take a look and pull some examples like we talked about yesterday to ensure that we are billing by block not by specimen.
Page 15 10/01/09 NCCL update 2010 Chapter 10...
8. The unit of service for special stains (CPT codes 88312-88313) and immunohistochemistry (CPT codes 88342, 88360, 88361) is each stain. If it is medically reasonable and necessary to perform the same stain on more than one specimen or more than one block of tissue from the same specimen, additional units of service may be reported for the additional specimen(s) or block(s). Physicians should not report more than one unit of service for a stain performed on a single tissue block. For example it is common practice to cut multiple levels from a tissue block and stain each level with the same stain. The multiple levels from the same block of tissue stained with the same stain should not be reported as additional units of service. Only one unit of service should be reported for the stain on multiple levels from the single tissue block. Additionally, controls performed with special stains should not be reported as separate units of service for the stain.

I am trying to get the right answer on this one...can anyone help me? My understanding is only 1 stain of same type per specimen.

 

[whaleheadking]

The client is correct. We haven't started doing this, but mainly because our documentation isn't in order to support that each block is being stained and interpreted.

If the report shows that the stains were done on different blocks and that they were medically necessary, I don't see a problem. I'm going to be giving it a try in a month or so. Good luck!

 

[mannlx]

we have started to do this , but documentation is the key. If your client is listing each stain per block ( even the same stain) that is billable now per the new guidelines. Physician must state stain xx was neg on blocks 1A, C and D. and you can bill 88342 X 3 units. Of course these stains must be medically necessary also.

 

[eandmcoder]

There seems to be a contradiction between sources. CMS' CCI manual does support billing by stain, specimen or block, as of 10/1/2010...

NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL FOR MEDICARE SERVICES, Version 16.3, Effective October 1, 2010, CHAPTER X: PATHOLOGY / LABORATORY SERVICES (CPT CODES 80000 – 89999), http://www.cms.gov/NationalCorrectCodInitEd/Downloads/NCCI_Policy_Manual.zip
“8. The unit of service for special stains (CPT codes 88312-88313) and immunohistochemistry (CPT codes 88342, 88360, 88361) is each stain. If it is medically reasonable and necessary to perform the same stain on more than one specimen or more than one block of tissue from the same specimen, additional units of service may be reported for the additional specimen(s) or block(s). Physicians should not report more than one unit of service for a stain performed on a single tissue block. For example it is common practice to cut multiple levels from a tissue block and stain each level with the same stain. The multiple levels from the same block of tissue stained with the same stain should not be reported as additional units of service. Only one unit of service should be reported for the stain on multiple levels from the single tissue block. Additionally, controls performed with special stains should not be reported as separate units of service for the stain.”

...but the 2011 CPT manual says "per antibody":
"88342 Immunohistochemistry (including tissue immunoperoxidase), each antibody"

...and the October CPT Assistant also says "per antibody":
"CPT code 88342, Immunohistochemistry (including tissue immunoperoxidase), each antibody, should be reported.... It is "each antibody" no matter how many blocks are applied to a given specimen."

Can anyone help resolve this apparent contradiction?

 

[whaleheadking]

CMS, through the NCCI manual, has stated the unit of service is stain per block. CK-4 performed on three separate blocks can be individually reported and billed if the documentation is explicit that "CK-4 preformed and interpreted on blocks 2, 4, 6 shows..." Individual commercial payers may vary but I have not found any explicit contraindications in what little research that I've done that disagrees with CMS' recommendations. The documentation shouldn't say "CK-4 x3 shows...." It should specify that what blocks the stain was performed on and the findings. If the documentation is precise, code it and bill it and cite the NCCI if you have to appeal.