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Question: How do I report estrogen receptor (ER) testing, and what is the correct ICD-10-CM code for documenting a tumor as ER+?

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Answer: The correct way to report ER testing depends on whether the provider counts the number of stained cells manually or uses a computer to help assess the slide. You’ll use 88360 (Morphometric analysis, tumor immunohistochemistry (eg, Her-2/neu, estrogen receptor/ progesterone receptor),quantitative or semiquantitative, per specimen, each single antibody stain procedure; manual) for the manual count, along with +0763T (Digitization of glass microscope slides for morphometric analysis, tumor immunohistochemistry (eg, Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen, each single antibody stain procedure, manual (List separately in addition to code for primary procedure)), which is the add-on code for slide digitization.

Report computer-assisted ER testing with 88361 (... using computer-assisted technology). No slide digitization add-on code is necessary for this test, as the “CPT^® code already recognizes the digitization process. Therefore, no additional digital pathology CPT^® code is needed,” according to the College of American Pathologists (CAP). 

ICD-10-CM coding for ER+ status will depend on what percentage of cell staining is reported in the test findings. This will be a matter of clinical judgement, though both the American Society of Clinical Oncology (ASCO) and the CAP recommend that “cancer samples with 1% to 100% of tumor nuclei positive should be interpreted as ER positive,” while “cancers with 1% to 10% of cells staining ER positive... should be reported using a new reporting category, ER Low Positive, with a recommended comment.”

As there is currently no ICD-10-CM code for ER low positive, the provider analyzing the test will assign Z17.0 (Estrogen receptor positive status [ER+]) to tests where at least 1 percent or more of the cells examined test positive for ER; and Z17.1 (Estrogen receptor negative status [ER-]) when test results indicate less than 1 percent. Per ICD-10-CM Code first guidelines for the Z17.- (Estrogen, and other hormones and factors receptor status) codes, the provider will also need to code first any malignant neoplasm, such as C50.- (Malignant neoplasm of breast) or C56.- (Malignant neoplasm of ovary).

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC