Pathology/Lab Coding Alert

Qualitative or quantitative distinguishes codes

If you've been nervously using modifier -59 (Distinct procedural service) to bill for your lab's immunohistochemistry (IHC) staining with morphometric tumor analysis you can come out of the shadows. CPT 2004 sports a brand-new code 88361 for just such a service allowing you to forget that pesky 88342/88358 National Correct Coding Initiative edit pair.

The new 2004 code is 88361 (Morphometric analysis; tumor immunohistochemistry [e.g. Her-2/neu estrogen receptor/progesterone receptor] quantitative or semiquantitative).

Before: Two Codes for Tumor IHC and Morphometry

In the past labs reported a positive/negative determination of tumor DNA by IHC using 88342 (Immunohistochemistry [including tissue immunoperoxidase] each antibody). Often the lab performed further quantification testing using tumor morphometric analysis and reported the additional service as 88358 (Morphometric analysis; tumor). For example a lab might perform a breast cancer HER-2/neu analysis by IHC and a tumor morphometry with pathologist interpretation to indicate the patient's suitability for Herceptin therapy.

But an NCCI edit pair in April 2003 prohibited you from reporting 88342 and 88358 together -- unless you used modifier -59 to override the edit. The College of American Pathologists (CAP) had protested the code pair arguing "that appropriate applications of tumor morphometry [88358] extend well beyond analysis of tumor DNA and that 88342 is a qualitative not quantitative determination of the presence or absence of an analyte." ("Special Report: National Correct Coding Initiative " Statline Sept. 15 2003.)

"This edit really confused long-accepted use of 88358 with 88342 " says Dennis Padget MBA CPA FHFMA president of DLPadget Enterprises Inc. a pathology business publication company in Simpsonville Ky. "In response to CAP's comments the NCCI medical director issued a letter distinguishing automated quantitative IHC billed as 88342 alone from nonautomated quantitative IHC billed as 88342 plus 88358."

After: One Code for Tumor IHC and Morphometry

"New code 88361 should solve the dilemma that the NCCI created for labs " Padget says. This single code clearly describes quantitative or semiquantitative tumor morphometry with immunohistochemistry. Labs often perform such tests for example a HER-2/neu assay to assess protein overexpression of the breast cancer marker.

"The code doesn't distinguish between automated or nonautomated so you should use 88361 to report any IHC-based procedure that includes a quantitative or semiquantitative element -- whether the machine or the pathologist does the counting " Padget says.

Your Payment May Increase or Decrease

Your lab's payment may go up or down under the new coding structure depending on how you used to charge for IHC with tumor morphometry. For example HER-2/neu will pay better than it did if you used to charge only 88342 due to NCCI edits but worse than it did if you used to charge for 88342 and 88358 with modifier -59. The 2004 Physician Fee Schedule nonfacility rates without regional conversion factor (GAF) are as follows: