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IHC stain done routinely for better diagnosis

  1. #1
    Default IHC stain done routinely for better diagnosis
    Medical Coding Books
    Our pathologists are now doing an IHC stain (CD3) routinely on small bowel bxs to r/o subtle early changes associated with celiac sprue. The changes may not be obvious on routine H&E staining. This is to r/o sprue. The stain is of great value in that it may increase diagnostic accuracy. Some specimens show no abnormality and the lab requisition does not state r/o celiacs, so would this stain be considered a medical necessity? Is it valid charging for the IHC stain? Does the referring Dr. have to request the pathologist to do whatever is appropriate to r/o a diagnosis for us to bill additional services aside from the surgical specimen?
    Any advice appreciated.

  2. #2
    I am not aware of what is considered best practice for this situation. I can tell you that our pathologists do not routinely do a CD3 on small bowel biopsies when asked to rule out celiac.

  3. #3
    Default CD3 on small bowel biopsies
    Hi, it's not common for our pathology department to use CD3 on small bowel biopsies. But I do know that working closely with my pathology department that when they receive a specimen that they are allowed to process it as they see fit. Which means if they need to apply stains (sometimes several stains) to rule in or rule out a diagnosis code that essentially it boils down to them making a solid diagnosis. It takes A LOT for any pathologist to put it on paper that Mr. or Mrs. Larson does or does not have carcinoma or lymphoma. The liability could be huge.
    When my team uses any stain I know they are using it to rule out or rule in a diagnosis. I am comfortable sending any of my team's pathology report for any denials that may arise.
    Essentially if your pathologist is documenting they applied such and such stain to rule out xxxxx I bet that would cover medical necessity, providing a reason why they are applying & interpreting the stain.
    Dana Chock, CPC, CCA, CANPC, CHONC
    Anesthesia, Pathology, and Laboratory coder

  4. #4
    Agree with above. The pathologist orders stains he/she feels are needed to make a clear diagnosis and with supporting documentation as described above. In some cases, the referring provider with request a specific stain to be done no matter what the pathologist sees, but this is not terribly common. We see this on occasion with H-pylori to help r/o H.pylori infection or the request of a PAS to rule out mycosis.

    I interpreted the original question as whether a CD3 should be done routinely on EVERY small bowel biopsy. Our group does not do a CD3 on EVERY small bowel biopsy - only when they feel it's necessary.

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