Pathology/Lab Coding Alert

Watch for common bundles you need to know.

Now that you’ve learned how to “Avoid 5 IHC Pitfalls and Get Home by 6,” in the preceding article, we’ll help you overcome one more roadblock to clean claims — Correct Coding Initiative (CCI) edits. 

We’ll help you zero in on CCI edits that might confound billing for 88360 (Morphometric analysis, tumor immunohistochemistry [e.g., Her-2/neu, estrogen receptor/progesterone receptor], quantitative or semiquantitative, each antibody; manual) and 88361 (…using computer-assisted technology). 

Choose One IHC Code Per Antibody

For a single IHC test, you have to choose the single most specific code for the service — either 88360 or 88361 for quantitative/semiquantitative tests, or one of the following codes for qualitative IHC tests:

• 88342 — Immunohistochemistry or immunocytochemistry, each separately identifiable antibody per block, cytologic preparation, or hematologic smear; first separately identifiable antibody per slide
• +88343 — …each additional separately identifiable antibody per slide (List separately in addition to code for primary procedure)
• G0461 — Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain
• G0462 — …each additional single or multiplex antibody stain (list separately in addition to code for primary procedure)

CCI reminds you to choose just one code by creating edit pairs for each of these code combinations.

Way out: If you perform two of these tests involving different antibodies (such as a qualitative ER and a quantitative Her2/neu), you can override the CCI edit and report the two appropriate codes together (such as 88342 and 88360). You’ll have to append modifier 59 (Distinct procedural service) to 88342 in this example to override the edit pair.

Beware Flow Cytometry Bundles

CCI also restricts reporting 88360 or 88361 together with flow cytometry codes 88184-88189 (Flow cytometry…). The CCI Policy Manual posits that IHC and flow cytometry (both immunologic techniques) represent redundant testing for the same medical condition on the same or “related” specimens (such as blood and bone marrow, bone marrow aspirate and biopsy, multiple lymph nodes). 

That means you can legitimately override the edit pairs with modifier 59 only if one of these conditions apply:

• The tests are for different medical conditions
• The tests are for the same medical condition but the first test is non-diagnostic or doesn’t explain the surgical pathology findings
• The tests are from different, unrelated specimens