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Thread: 88343

  1. #1

    Default 88343

    Has there been an update to the 88343 addition to the 2014 book? Has MCR accepted this CPT code per slide / block?

  2. #2
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    Greater Pittsburgh
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    88343 will be the add on code to 88342 starting in 01/01/2014....we are going to be able to bill per block for these stains now...it is still unknown whether or not medicare is going to accept this...guess thats just gonna be a try it and see when the time comes scenario

  3. #3
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    Quite and uproar about this in our office - and a lot of confusion. Go to page 360 in this document to read Medicare's decision about this. http://www.ofr.gov/OFRUpload/OFRData/2013-28696_PI.pdf

    "The CPT Editorial Panel revised the existing immunohistochemistry code, CPT code 88342 and created a new add-on code 88343 for CY 2014. Current coding requirements only allow CPT code 88342 to be billed once per specimen for each antibody, but the revised CPT codes and descriptors would allow the reporting of multiple units for each slide and each block per antibody (88342 for the first antibody and 88343 for subsequent antibodies). We believe that this coding would encourage overutilization by allowing multiple blocks and slides to be billed.
    To avoid this incentive, we are creating G0461 (Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain) and G0462 (Immunohistochemistry or immunocytochemistry, per specimen; each additional single or multiplex antibody stain (List separately in addition to code for primary procedure)) to ensure that the services are only reported once for each antibody per specimen. We believe this will result in appropriate values for these services without
    creating incentives for overutilization."

    Some of our docs are participating in conference call today with CAP to help clarify what this all means.

  4. #4
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    Presque Isle, Maine chapter
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    Default 88342 and 88343

    My pathologist is asking me (his billing agent) to advise him on this as well so I hope any updated information continues on this issue.

  5. #5
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    My manager told me that the webinar with CAP yesterday did not really clarify exactly how to use the codes. We are planning to wait a few days with the assumption that Padget will send out an update.

  6. #6
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    Padget did issue an alert yesterday, 12/5. It's quite lengthy and I haven't had a chance yet to examine all of it. I will post something here when I've read through it carefully.

  7. #7
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    Here is a summary of changes from CAP: http://www.cap.org/apps/cap.portal?_...geLabel=cntvwr

    I can't post Padget's document here because of copyright. I can summarize parts of his discussion.

    As of Jan 1, 2014, 88342 and newly created 88343 will not be valid for Medicare. Medicare has instead created codes G0461 and G0462.

    For non-Medicare patients, pending any restrictions from specific payors, we will continue to use 88342 and new code 88343.
    88342 Immunohistochemistry or immunocytochemistry, each separately identifiable antibody per block, cytologic preparation, or hematologic smear; first separately identifiable antibody per slide.
    88343 (add-on code must be used with 88342) each additional separately identifiable antibody per slide (List separately in addition to code for primary procedure)

    Note "per block" as a change from "per specimen." Also note "per slide" in reference to cocktails or multiplex IHC stains (e.g. PIN-4). Thus, for non-Medicare patients, the only time we will use 88343 is with cocktails. Instead of reporting 88342 X 3 for one block of a PIN-4, we will report 88342, 88343 X 2.

    The new Medicare codes are:
    G0461 Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain)
    G0462 Immunohistochemistry or immunocytochemistry, per specimen; each additional single or multiplex antibody stain (List separately in addition to code for primary procedure).

    Note "per specimen." Also note that it says "first single" OR multiplex stain. That means the PIN-4 will be coded G0146 X 1.

    How we code to Medicare non-multiplex stains will change. For example, ER, PR, Her-2 will now be coded G0461 X 1, G0462 X 2.

    Padget also states the reporting per specimen rather than block applies to Medicare, Tricare and Medicaid, but it is not clear to me whether we should use 88342/88343 or the G-codes with Tricare and Medicaid.

    Padget also discusses the changes in prostate biopsy coding, summarized here from the CAP web site: "In its decision, CMS established new G codes (G0416-G0419) which will apply to all prostate biopsies (regardless of surgical technique) when 10 or more specimens are reviewed. Increased scrutiny in the reporting of multiple prostate biopsy specimens led to this policy change. Prostate biopsies with fewer than 10 specimens should be billed using CPT code 88305." Note the change: regardless of surgical technique - not just saturation biopsies.
    Last edited by bbooks; 12-09-2013 at 01:08 PM. Reason: Add paragraph prior to last paragraph.

  8. #8
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    Another resource for information on 2014 changes: http://www.ascp.org/Advocacy/ePolicy...mber-2013.html

  9. #9
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    One more thing. For non-Medicare cocktails, if I understand this correctly, 88343 will only be used when the cocktail produces individually identifiable and reportable antibodies, like with the PIN-4. Something like AE1/AE3 would still be one charge of 88342.

  10. #10

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    Who is Padget, and where could I get access to the alert you are summarizing from? We've been trying to figure this out for our dermatopathologists.

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