Pathology/Lab Coding Alert

"These codes clearly describe three different types of IHC analysis - qualitative (88342), quantitative by manual morphometric analysis (88360), and quantitative by computer-assisted morphometric analysis (88361)," says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc., a pathology business publishing company in Simpsonville, Ky. So you report a breast tissue Her-2/neu IHC test using the one code that describes how the pathologist performed the exam.

Sharpen Your 2005 IHC Coding With Clinical Examples

Look at these three examples, and study the "new way" and "old way" to see how CPT 2005 solves some serious coding dilemmas.

1. The pathologist examines an IHC stained breast tumor tissue slide and reports a "positive" result for the Her-2/neu protein, which is a qualitative result.

2. The pathologist examines an IHC stained breast tumor tissue slide, counts the stained nuclei, and reports a percent positivity estimate or "scores" the slides using a system such as 0, 1+, 2+, 3+ for Her/2-neu, which is a semiquantitative result.

3. The pathologist examines an IHC stained breast tumor tissue slide, selects areas for precise analysis by ChromaVision Automated Cellular Imaging System (ACIS), and reports the precise percentage of Her-2/neu-stained nuclei, which is a quantitative result.

New Way:

1. Report this qualitative IHC study using one unit (antibody) of 88342.

2. Use new code 88360 to describe this semiquantitative IHC tumor exam that the pathologist performs manually, says Joan Logue, BS, MT-ASCP, principal with Health Systems Concepts Inc. in Longwood, Fla. "Be sure you do not separately report the IHC stain using 88342; the morphometric analysis codes 88360 and 88361 include the IHC stain service," she says.

3. Use revised code 88361 to describe the quantitative IHC computer-assisted Her-2/neu morphometric analysis study, Logue says.

Old Way:

1. Nothing's changed here - you've always reported this qualitative IHC study using 88342.

2 and 3: Before CPT 2004 added 88361, you would have reported examples 2 and 3 the same way: using one code for the IHC stain and a separate code for the morphometric analysis. "Before April 2003 NCCI edits disallowed it, we would report 88342 for the IHC breast tumor Her-2/neu, plus 88358 (Morphometric analysis; tumor) for the morphometric analysis," Logue says. You used these codes whether the morphometric analysis was manual or computer-assisted.

2. CPT 2004 allowed coders to overcome the NCCI edit problem by reporting new code 88361 (2004 definition: Morphometric analysis; tumor immunohistochemistry [e.g., Her-2/neu, estrogen receptor/progesterone receptor], quantitative or semiquantitative) for the combined qualitative and quantitative morphometric analysis service, with no distinction between manual and automated methods. But CMS disagreed, reserving 88361 for quantitative IHC using "computer software analysis of stained microscopic slides."

"CMS' statement left coders nowhere to turn when their pathologist performed an IHC with manual morphometric analysis. When coding for Medicare cases in 2004, people reported this service as either 88342 or 88358. However, for non-Medicare, most everyone reported 88361," Padget says.

3. 2004's codes were clear for automated IHC tumor morphometry. "Code 88361, new in 2004, described the IHC plus computer-assisted tumor morphometry for both Medicare and all other payers," Logue says.