Hello
SBilb89,
Yes, I am. I had to do some digging to find a "free" solid pathology resource that I could reference to assist with answering your question today.
This is the file I am referring to is from Medicare NCCI 2023 Coding Policy Manual. The Chapter X Pathology / Laboratory Services CPT Codes 80000-89999.
Let's review page X-18 item #11 together okay for proper assignment of CPT 88366 step by step.
11. The unit of service for in situ hybridization reported as CPT codes 88364-88369,
88373, 88374, 88377 is each single or multiplex probe staining procedure per specimen. If a
single or multiplex probe staining procedure is performed on multiple blocks from a surgical
specimen, multiple slides from a cytologic specimen, or multiple slides from a hematologic
specimen, only one unit of service shall be reported for each separate specimen.
Let's discuss Paragraph One: It is stating that we may only bill one CPT code "
PER A SPECIMEN". You cannot bill if performed on multiple anything. It is one per a specimen in summary.
Providers/suppliers shall not report more than one unit of service for CPT codes 88366, 88374,
or 88377 per specimen for each multiplex probe staining procedure even if it contains multiple.
separately interpretable probes.
Let's discuss Paragraph Two: It is stating in summary that if you bill the multiplex code 88366 for example,
it encompasses all of the multiprobes utilized.
A multiplex probe staining procedure is one that uses multiple probes to obtain multiple
separately reportable medically reasonable and necessary results. A probe stain containing
multiple probes that yields a single reportable result is not a multiplex stain and shall be reported
with a single probe staining procedure CPT code.
Let's discuss Paragraph Three:
If multiple probes are utilized but only provides a single result (that is not deemed a multiplex and should by NCCI be reported with a single probe CPT code as appropriate).
I have to believe that your pathology department may be utilizing multiple probes at the same time, reviewed under microscope reviewing the various color-coded signals at the same time; providing their professional interpretation of both the Kappa and Lambda ISH that was performed. There should be in their interpretation a statement that references each the Kappa and Lambda within the pathology report to support billing the multiplex charge along with documentation that multiple probes were performed and reviewed simultaneously. Check their comments and disclaimers within pathology report.
I do apologize in advance for being super lengthy here, there wasn't a definitely cut and dry answer here.
If anyone watching my comments has more to offer that I may have missed on my lengthy post (please feel free to add).
Have a fantastic evening,
Dana