Pathology/Lab Coding Alert

Question: We run HPV sub-typing for high-risk and low-risk strains on two blocks from the same specimen. Can we bill 88365x4 or just 88365x2?

Texas Subscriber

Answer: Reporting 88365x4 is definitely incorrect for this scenario.

If you perform qualitative HPV sub-typing by in situ hybridization (ISH) as an adjunct to a surgical pathology case, such as a tissue specimen for cervical cancer, you’re correct to choose 88365 (In situ hybridization [e.g., FISH], each probe). Because the unit of service is “each probe,” you should report one unit for the low-risk HPV probe and one unit for the high-risk HPV probe.

Caution: You can only use 88365 if a pathologist performs the interpretation — not a PhD laboratory professional. In that case, you’ll have to select 88271 (Molecular cytogenetics; DNA probe, each [e.g., FISH]) for the test.

Unit of service: As with most surgical pathology procedures, the unit of service for 88365 is based on the specimen, not the block. That’s why you should not report 88365x4 even if you evaluate both probes on each of two blocks from the same specimen.