Immunohistochemical stains added at a later time

kduty

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What is the best way to code additional IHC stains done to a pathology report by another pathologist?
The original pathologist ordered another IHC and asked a colleague to read and sign out an addendum since he was going on vacation. The second pathologist did a corrected report instead of an addendum so made things way more complicated.
Any suggestions to pass on to the pathologists would be very appreciated.



Origianal Pathologist:
Immunohistochemical stains were performed with appropriate controls. The tumor cells are positive for synaptophysin (88342) and negative for CDX-2(88341). A CD45(88341) stain was performed and highlights infiltrating lymphocytes and is negative in tumor cells. An Alcian blue stain(88313) with appropriate control demonstrates intestinal metaplasia with no evidence of infiltrating signet ring cells.

Corrected addition by second pathologist:
Ki67(88341?) IHC (controls appropriate) shows positivity in approximately 1-2% of neoplastic cells.
 

danachock

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What is the best way to code additional IHC stains done to a pathology report by another pathologist?
The original pathologist ordered another IHC and asked a colleague to read and sign out an addendum since he was going on vacation. The second pathologist did a corrected report instead of an addendum so made things way more complicated.
Any suggestions to pass on to the pathologists would be very appreciated.



Origianal Pathologist:
Immunohistochemical stains were performed with appropriate controls. The tumor cells are positive for synaptophysin (88342) and negative for CDX-2(88341). A CD45(88341) stain was performed and highlights infiltrating lymphocytes and is negative in tumor cells. An Alcian blue stain(88313) with appropriate control demonstrates intestinal metaplasia with no evidence of infiltrating signet ring cells.

Corrected addition by second pathologist:
Ki67(88341?) IHC (controls appropriate) shows positivity in approximately 1-2% of neoplastic cells.
So it is a corrected report rather than an addendum; the Ki-67 is quantitative; this procedure would actually be billed with 88360.
How to code it? What was the final diagnosis with any additional notes, intraoperative interpretation or microscopic stating? Please use that.
How long after the original pathology did this additional charge (Ki-67) get ordered? If it was beyond 30 days you may need a new encounter?? I'm unsure for you - but that is my facility's policy and may differ from yours.
However, if you are simply asking how to bill the "add on" procedure (Ki-67) so that the colleague pathologist receives RVU's? I am unsure what system you are utilizing but in Epic (the system we utilize) we would update and change the service provider just on the professional fee for that the line item so they receive the RVU's.
I hope that this helps, and please reach out if you have more questions.
Have a great evening!
Dana Chock
 

ldr_cpc

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I have an example on IHC stains added at a later time:


Original report:

BLOCK A1
Antibody Result
H.pylori Negative 88342-26
CDX-2 Highlights carcinoma cells 88341-26
P63 Highlights carcinoma cells 88341-26


Addendum:

BLOCK A1
Antibody Result
P40 negative 88341-26
AE1/AE3 negative 88341-26




For this example, do we add a modifier 59 to the additional 2 units of 88341-26 (P40 and AE1/AE3)

or

do we correct the units of the 88341-26 that was previously submitted to 4 units (CDX-2, P63, P40, AE1/AE3)?

Thank you
 

danachock

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I have an example on IHC stains added at a later time:


Original report:

BLOCK A1
Antibody Result
H.pylori Negative 88342-26
CDX-2 Highlights carcinoma cells 88341-26
P63 Highlights carcinoma cells 88341-26


Addendum:

BLOCK A1
Antibody Result
P40 negative 88341-26
AE1/AE3 negative 88341-26




For this example, do we add a modifier 59 to the additional 2 units of 88341-26 (P40 and AE1/AE3)

or

do we correct the units of the 88341-26 that was previously submitted to 4 units (CDX-2, P63, P40, AE1/AE3)?

Thank you

Well, this all kind of depends on when the "add on" charges were ordered.

Let me explain using your example okay; allowing me to provide some fictitious dates for this.

1st example (with "add on" charges ordered WITHIN the 30 calendar days excluding holidays and weekends of original specimen received).
H pylori 88342
CDX2, P63, p40, AE1/AE3 with 88341
Bill all charges for pathology with the received date of specimen.
Note: We don't quantity bill at our facility. Subsequent charge for 88341 would have an XS. (We do not utilize Modifier 59).

2nd example (with "add on" charges ordered beyond the 30 days)
Original specimen received 09/01/2021
Billed with 88342 (H pylori) and 88341 for each additional line for the (CDX2 and P63) the P63 would have an XS modifier for DOS 09/01/2021.

Usually at this point something has happened to our patient due to radiology, other biopsy(s) etc.. and a provider needs additional testing performed.
So they requested that the p40 and AE1/AE3 to also be done which was ordered on 11/01/2021; this is more than the 30 days and at both healthcare facilities that I work for, we follow the Medicare rules on when the specimen is collected and whether it is "current" or "archived".

Okay at this point what should happen is that an encounter for those "add on" procedures with DOS 11/01/2021 should be created.
Note: we would not want to bill 88341 on two lines with subsequent charge with Modifier XS.
The reason I state this is because your claim will or should get stuck in your system. We have many edits that help us fix those front end problems and the problem here is that you are billing two "add on" charges 88341 without a "primary" procedure and so it should error out in your system. If it doesn't - the recipient of the medical invoice should deny it for not being billed correctly. The add on procedure (88341) was not billed with a primary procedure (88342).

If you need additional information on the timing of this - please find locate this article - MLN Matters Number: MM 4156. If you have problems finding it; please reach out for assistance. MLN = Medicare Learning Network.

I hope utilizing your example using some fictitious dates provides the background and information you were searching. With new IHC stains being introduced all the time, I see this quite a bit where I work. They will at the request of a provider, process archived specimens with hope that a new IHC stain will be able to provide additional information for treatment options.

Have a great evening and again if you have any questions please reach out.
Dana Chock
 

ldr_cpc

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2nd example (with "add on" charges ordered beyond the 30 days)
Original specimen received 09/01/2021
Billed with 88342 (H pylori) and 88341 for each additional line for the (CDX2 and P63) the P63 would have an XS modifier for DOS 09/01/2021.

Usually at this point something has happened to our patient due to radiology, other biopsy(s) etc.. and a provider needs additional testing performed.
So they requested that the p40 and AE1/AE3 to also be done which was ordered on 11/01/2021; this is more than the 30 days and at both healthcare facilities that I work for, we follow the Medicare rules on when the specimen is collected and whether it is "current" or "archived".

Okay at this point what should happen is that an encounter for those "add on" procedures with DOS 11/01/2021 should be created.
Note: we would not want to bill 88341 on two lines with subsequent charge with Modifier XS.
The reason I state this is because your claim will or should get stuck in your system. We have many edits that help us fix those front end problems and the problem here is that you are billing two "add on" charges 88341 without a "primary" procedure and so it should error out in your system. If it doesn't - the recipient of the medical invoice should deny it for not being billed correctly. The add on procedure (88341) was not billed with a primary procedure (88342).

On the second example, since p40 and AE1/AE3 were ordered beyond the 30 days and a new encounter was created (11/01/2021) then would we bill this as 88342 and 88341?

Thank you
 

danachock

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Yes, that is how I would bill it. Like I stated earlier everything is based off the day of service. If IHC is applied within the 30 days of collection - you use the collection date. If it is past that 30 day threshold, you will want a new encounter and utilize the date that the "add on" IHC were ordered and bill it that way.
I don't have written proof of this (only logical rationale with working with both rejections and denials for several years that billing quantity 88341x2 solo [with a different encounter date & no other charges from our facility with that that new ordered IHC date of service] will receive a rejection or denied once the claim is received.

So my question is - how can any insurance company pay for an "add on" code 88341 when the primary code 88342 wasn't billed with it?? Especially solo without any other charges?
I am interested; if anyone else has something to offer on this I would appreciate their insight.

Thank you for listening and have a great evening.
Dana
 
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