Pathology/Lab Coding Alert

Automation distinction is the key You can stop pulling out your hair over how to report manual versus computer-assisted morphometric analysis using immunohistochemistry (IHC) or in situ hybridization (ISH). CPT Codes 2005 adds and revises several codes in the 88360s, largely to distinguish manual from automated IHC and ISH studies.

The code changes clear up other questions too - like whether to report the  ISH per probe, and how to overcome National Correct Coding Initiative (NCCI) edits that had stopped your lab from capturing some qualitative and quantitative IHC and ISH services.

Just follow our experts' examples of the "new way" and the "old way" to see how CPT 2005 will solve your morphometric analysis coding problems. Distinguish ISH Quantification/Automation With 3 Code Options By changing an existing code and adding two new codes, CPT 2005 gives you three options for reporting ISH.

Paralleling the change for IHC coding (see "IHC Coding Basics: Know Method for CPT 2005" on page 92), the 2005 code update distinguishes between qualitative and quantitative tests and between manual and automated methods. The new and revised codes are:

 88365 - In situ hybridization (e.g., FISH), each probe (Do not report 88365 in conjunction with 88367 or 88368 for the same probe)

 88367 - Morphometric analysis, in situ hybridization (quantitative or semiquantitative) each probe; using computer-assisted technology

 88368 - ... manual.   "The note following revised code 88365 confirms that it's to be used only with qualitative ISH tests, while two separate new codes now describe today's more common quantitative tests," says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc., a pathology business publishing company in Simpsonville, Ky.

Example: You should report fluorescence ISH (FISH) breast-tissue Her-2/neu tests that use morphometric analysis to quantify gene overexpression as 88367 or 88368, depending on whether the pathologist counts the slide manually or using computer-assisted technology. "Don't report 88365 in addition to 88367 or 88368 for these tests," says Laura Edgeworth, HTL, CPC, coding and audit specialist with Pathology Service Associates LLC (PSA), in Florence, S.C.

'Each Probe' Solves ISH Unit-of-Service Mystery What is the unit of service for ISH tests? You should report the analysis per DNA probe, according to CPT 2005.

Before the latest code updates, the answer to the unit-of-service question was not so clear. "Experts and the AMA used to advise that 88365 included multiple probes, but the use of 'each probe' in the CPT 2005 definition clarifies that this is no longer the case," Padget says. Codes 88365, 88367 [...]