Question Pathology CPTs

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Lubbock, TX
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Good morning,

I am trying to comprehend when it's appropriate to code for 88360 vs 88342 for stains such as ER, PR, Ki-67, PTEN, BCL-2 and SDHB when done in-house and sent out as Tech only. I have seen someone else ask recently about this same question but I would like to give a couple of scenarios for my better understanding.

Case 1:
Comment: The morphology and immunoprofie supports high grade neuroendocrine carcinoma, however Ki-67 (proliferation marker) is in progress.
Addendum: Ki-67: Very high ( >90%) proliferation indes. These results supports small cell carcinoma.

Question: Can this Ki-67 be coded as 88360 because it has the percentage or would it be a normal 88342/88341?

Case 2:
Comment: The following immunohistochemical stains were performed with appropriate positive and negative controls:
CD10: Positive in uterine stromal cells
ER: Positive
p53: Wild type
PTEN: Retained
BCL-2: Retained
PAX2: Lost (patchy)

These results supports the final diagnosis.

PTEN, BCL-2 and PAX2 stains were performed at ********* Laboratories and interpreted at ************* Department of Anatomic Pathology.

Question: I know the ER stain in this case would be 88342/88341 but what about the three stains done at technical component done at outside lab and interpreted by our path? When we receive tech stains from the outside laboratory, we receive a statement of what we are receving (test performed) and what they are billing. The PTEN, BCL-2 and PAX2 stains are always billed as 88360 (outside statement) but when I see this report, I don't see percentages (quantitative) so I would code as 88342/88341. Am I right to do this or should I be coding what the outside lab is coding? What is the difference between qualitative and quantitative? To me, qualitative is a simple positive/negative and quantitative is percentage.

Case 3:

DOS: 4/11 and completed 4/15
The following immunohistochemical stains were performed with appropriate positive and negative controls:
The tumor cells are positive for Vimentin, ER, CK7 (patchy). P53 is wild type, negative for CK 20.
P16 is patchy and weak. These results supports the final diagnosis (Endometrial endometrioid adenocarcinoma)
5/03 - Addendum:
ER: Positive
- Tumor stained: 90%
- Intensity: strong
PgR: Positive
- Tumor stained: 80%
- Intensity: strong

Question: This case was billed immediately after completion but then two weeks later the oncologist came back and asked ut to perform the ER/PR. Initially, the ER stain was billed as 88342/88341 but when charges were corrected, I removed 1 stain from 88341 and billed 88360 x 2. Did I do this correctly or was I able to leave the IHC stain charge? Because to my understanding, the 88360 is like a bundled code (IHC - Qualitative & percentage - Quantitative) Do I understand correctly?

Please know that I really appreciate the time you are taking to review my questions. Thank you :)
 

danachock

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Brainerd, MN
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Hi Lupita1983,

Case 1:

I wouldn’t hesitate to code the Ki-67 with 88360 in this scenario – per SEER the Proliferation Index — high rates indicate actively growing tumors and a greater risk of relapse and having the percentage stating it is >90% that is why I would select that CPT assignment. Let’s go back to reviewing our CPT book at this point okay please. 88360 states “morphometric analysis, tumor immunohistochemistry, (eg; Her2, ER, PR) quantitative or semi-quantitative, per specimen, each single antibody stain procedure, manual. If a pathologist applies a stain and refers to something else (NOT tumor cells) and states that bone marrow cellularity is high or low. As a pathology coder I cannot support billing 88360, I would refer to 88342/88341 unless someone else has additional guidance on this coding scenario.

Case 2:

No, I would not follow suit with the “outside facility” on this scenario. The PTEN, BCL-2, and PAX2 are not quantitative. I would bill the appropriate (88342/1) professional fees only – because an outside facility provided the technical fees. They applied the immunohistochemical stains to the block or slide(s) and sent it back to your facility for your company pathologist’s professional interpretation. I would simply note this in my notebook and if I was ever audited, you have your resource. That “outside” facility may not know any better at assigning codes, new at their position, or several other reasons. You, as the coder know better. If you are ever audited.

Case 3:

In my opinion, the original ER that was billed with the original charges should have been billed with either 88342/1. Later after the addendum was completed, and when additional charges populated for these pathology charges. I would have billed this with a quantitative morphometric charge 88360x2 for the ER and PR. I could care less what billing program anyone utilizes to state that that 88342/88341 are bundled with 88360. It is simply not the same stain and I will appeal these cases repeatedly to prove my point. I will provide the pathology report to identify in the microscopic area that the ER was performed (4/11) and when the addendum was completed (unsure on the exact date but the pathology report “would be time stamped”) even if it was billed within the original 30 days.

I do apologize if I missed anything but there was quite a bit there to digest this evening, but if you need additional help, please feel free to respond.
Have a fantastic evening!
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT
 

danachock

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Brainerd, MN
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You are welcome Lupita1983, I have been on the pathology forums for several years (just search it) to suggest stuff to seriously help and assist our pathology colleagues.
No worries, go ahead and ask others to "pick their brains" and figure it out.
I am clearly not needed at this point, and I will just wish you and your team complete success okay!!
Have a fantastic evening!
Dana

PS. I did want to share an ideal pathology statement of the wording for the application of 88360 I saw working yesterday.
"On HER2 immunohistochemical testing performed at XXXX, >95% of the tumor is HER2 negative (0)."
 
Last edited:
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Lubbock, TX
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Good morning, Dana,

Thank you, I really appreciate your response to all my different scenarios. 🙌 I wanted to pick more brains before I run with it. This was very helpful. Have a blessed Fabulous Fri-Yay and weekend. :)
 
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