Pathology/Lab Coding Alert

Count specimens -- or maybe blocks to get all the pay you deserve

For years the immunohistochemistry unit-of-service standard has been "per stain per specimen." But what if you have multiple blocks and slides from a single specimen, and the case involves an immunohistochemistry stain on multiple slides from each block -- as is often the case. Should you still report just one unit? The answer is -- that depends. According to coding convention supported by the AMA and the College of American Pathologists, the answer is yes: the unit of service for IHC stains is "per stain, per specimen."

Take Note of Medicare Instruction

In a departure from common coding practice, Medicare's Correct Coding Initiative (CCI) Policy Manual version 15.3 states, "If it is medically reasonable and necessary to perform the same stain on more than one ... block of tissue from the same specimen, additional units of service may be reported for the additional ... block(s)."

Caution: The manual goes on to clarify that if the lab cuts multiple levels from a single tissue block and stains each level with the same stain, you should not report additional units of service for the stain.

Do this: "Common sense and equity say Medicare is closer to being 'right' on this matter than the AMA," claims Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc. and publisher of the Pathology Service Coding Handbook, in The Villages, Fla.

"The physician and laboratory work for IHC stains is clearly more closely related to the block than the specimen, so I believe pathologists and laboratories should extend Medicare's prescription for IHC unit of service to all financial classes of patients," says Padget. "But this has to be a group/laboratory decision, blessed by the compliance officer or committee," he cautions.