Pathology/Lab Coding Alert

Distinguish TC, 26 modifier use.

Now that you’ve read about the different code families for in situ hybridization (ISH), you need to grasp the huge difference in how to represent the physician professional work involved in the procedures.

Use Modifiers With Global Codes

Codes +88364-88377 and 88120-88121 are global codes. That means when you report the code without a modifier, you’re claiming the work of both the technical service, such as preparing the slides, and the professional (physician) service, such as interpreting and reporting on the test. The Medicare Physician Fee Schedule (MPFS) lists a payment amount for the global code, plus a sub-divided payment amount when you report the code with modifier TC (Technical component) or 26 (Professional component).

“In other words, the global codes inherently involve professional interpretation by the pathologist as an adjunct to the histopathology or cytopathology case,” says R.M. Stainton Jr., MD, president of Doctors’ Anatomic Pathology Services in Jonesboro, Ark.

Use Different Strategy for Clinical Tests

When you report codes from the 88271-88275 family, you’re not representing any physician professional work. Medicare pays for these codes on the Clinical Laboratory Fee Schedule (CLFS) not the MPFS.

Although these codes don’t inherently involve a professional interpretation, a pathologist may need to interpret the test results, in some cases. You should report that professional service as 88291 (Cytogenetics and molecular cytogenetics, interpretation and report) for interpretation of the entire cytogenetics study, possibly including multiple probes and cell counts.

Medicare alert: CMS assigns 88291 a Medically Unlikely Edit (MUE ) of 1 and considers the code to represent the interpretation and report of “all cytogenetic/molecular cytogenetic testing performed on a single date of service,” according to the NCCI Policy Manual.