Pathology/Lab Coding Alert

Only 88342 allows ‘per block.’

Problem: The same immunohistochemistry (IHC) antibody by a different method (qualitative versus quantitative/semiquantitative) requires a different unit of service.

That’s the take away message from CPT® 2014 changes that revised 88342 (Immunohistochemistry or immunocytochemistry, each separately identifiable antibody per block, cytologic preparation, or hematologic smear; first separately identifiable antibody per slide) but left 88360 (Morphometric analysis, tumor immunohistochemistry [e.g., Her-2/neu, estrogen receptor/progesterone receptor], quantitative or semiquantitative, each antibody; manual) and 88361 (…using computer-assisted technology) unchanged.

Stay With Specimen

With no change in CPT® 2014 for 88360-88361, pathologists have to rely on existing coding convention and instruction for reporting those services. That means sticking with the specimen as the unit of service.

The current National Correct Coding Initiative Policy Manual states: “For immunohistochemistry reported as CPT® codes 88360 or 88361, the unit of service is each antibody(s) stain (procedure) per specimen.”

Establish Your Policy

So the problem is tee’d up: You can’t bill qualitative IHC per block for Medicare, and you can’t bill quantitative/semiquantitative IHC (88360-88361) per block to anyone. Should you bother to switch to billing per block for 88342 for non-Medicare payers?

“You might very well decide simply to ignore the ‘per block’ change the AMA now offers to avoid the internal confusion and hassle of figuring out who and when you can bill ‘per block’ versus ‘per specimen’ and the extra cost associated with handling expected denials, corrected claim filing, audit exposure, and the like,” says Dennis Padget, MBA, CPA, FHFMA, The Villages, Fla., Senior Editor in Chief, Pathology Service Coding Handbook, for American Pathology Foundation. “In fact, you might find that many private insurers won’t honor the ‘per block’ basis of charge either,” he says.