Pathology/Lab Coding Alert

Catch 'status' diagnosis codes.

After the pathologist's work outlined in "Track Each Test Phase to Boost Breast Specimen Pay" on page 49, you might find that the physician orders additional ancillary testing to help determine appropriate treatment protocols.

Study the following scenario, then check our expert's advice to zero in on the correct coding -- and the correct pay -- for your pathologist's work.

Check Out This ER/PR Scenario

To assist in determining appropriate radiation and/or chemotherapy treatment following surgical removal of an infiltrating ductal carcinoma, the patient's physician may order tissue tests for estrogen receptor/progesterone receptor (ER/PR) status.

The lab performs ER/PR immunohistochemistry (IHC) stains on the breast tumor tissue, and the pathologist evaluates the slides to make a qualitative determination of whether the tissue demonstrates weak, moderate, or strong staining intensity.

Based on the findings of weak staining for ER and strong staining for PR, the pathologist diagnoses the breast tissue as ER negative and PR positive, indicating that the cancer should respond well to progesterone suppression treatments.

Code IHC and Findings

Should you code the ER/PR test as 84233 (Receptor assay; estrogen) and 84234 (... progesterone)?

The answer is "no." Codes 84233 and 84234 describe clinical lab tests for ER/PR, which typically use a biochemical ligand-binding assay method.

Do this: Because the ancillary service in this case involves qualitative tissue IHC stains, you should code the service using 88342 (Immunohistochemistry (including tissue immunoperoxidase), each antibody).

You should list two units of 88342 -- one for each antibody stain performed (ER and PR). Don't report additional 88342 units for multiple blocks or slides -- the unit of service for the code is each antibody, per specimen.

Report findings: "List ER negative findings as V86.1 (Estrogen receptor negative status [er-])," says Melanie Witt, RN, COBGC, MA, an independent coding consultant in Guadalupita, N.M.

ICD-9 doesn't provide a specific code for PR status, so you should simply report the ICD-9 code the breast cancer and any ER status findings, according to Witt.