Pathology/Lab Coding Alert

UroVysion® finds its code niche.

If you've been confused about how to report urine specimen in situ hybridization (ISH) for bladder cancer, you're not alone. But CPT 2011 has the answer --" two new codes that save you from an unlisted code or ISH code family confusion.

Distinguish Urinary Tract Specimens

Before CPT 2011, you didn't have specific codes for urinary tract specimen fluorescence ISH (FISH) tests.

Problem: A quick survey of labs and payers shows four different recommended ways to code for urine-based recurrent bladder cancer FISH testing prior to 2011:

• 88299 -- Unlisted cytogenetic study
• 88367 x 4 -- Morphometric analysis, in situ hybridization (quantitative or semiquantitative), each probe; using computer assisted technology
• 88368 x 4-- ... manual
• 88271 x 4 -- Molecular cytogenetics; DNA probe, each [e.g., FISH] plus 88274 (Molecular cytogenetics; interphase in situ hybridization, analyze 25-99 cells).

Solution: CPT 2011 introduces two new codes to describe the test:

• 88120 -- Cytopathology, in situ hybridization (e.g., FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; manual
• 88121 -- ... using computer assisted technology.

"New CPT codes 88120 and 88121 specifically accommodate tumor morphometric analysis by in situ hybridization, such as FISH, on urinary tract specimens," says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc. and publisher of the Pathology Service Coding Handbook, in The Villages, Fla.

"A prominent example of the type of test that falls under code 88120 or 88121 instead of 88368 or 88367 is UroVysion® FISH detection for recurrent bladder cancer," Padget says.

Units solved: Some payers have refused to pay four units of 88367 or 88368 for UroVysion® FISH because the test doesn't include an interpretation for each probe. "New codes 88120 and 88121 should end that debate, because you'll only bill one unit for the four-probe UroVysion® FISH test," Padget says.

Beware 'more than five': You should not report 88120 or 88121 if the test you're using analyzes more than five molecular probes. CPT 2011 adds a new text note that states, "For more than 5 probes, use 88399."

Differentiate 'Manual' or 'Computer Assisted'

Because CPT 2011 adds two codes, you'll need to know how to choose between 88120 and 88121. The distinction focuses on whether the procedure involves a person manually counting cells and probe signals (88120), or whether the count is performed by a computer (88121).

The distinction is important for the familiar UroVysion® FISH test. "UroVysion® is performed manually and by automated methods," acknowledges Abbott spokesman Don Braakman.

Know Specimen Type

Codes 88120-88121 describe ISH tests on urinary tract specimens such as urine or bladder washings. The test involves analysis of cellular material in the fluid -- it's a cytopathology specimen, not a tissue specimen.

To ensure that you only use 88120-88121 for urinary tract specimens and continue using existing codes for other cytology specimen ISH, CPT 2011 adds the following text note, "For morphometric in situ hybridization on cytologic specimens other than urinary tract, see 88367, 88368."

For instance: "You should still report PathVysion® Her-2/neu FISH as two units of 88368 or 88367," Padget says.

What Will it Cost You?

If your lab reported UroVysion® or related urinary tract FISH testing as 88367 x 4 or 88368 x 4, you're in for sticker shock with the new codes. Look at the following payment differences for the professional and technical components for Pricing based on revised 2011 Medicare Physician Fee Schedule national amount non-facility total using conversion factor 33.9764