Pathology/Lab Coding Alert

Question: Our lab performs the CellSearch® test to evaluate circulating tumor cells in patient blood specimens following treatment for breast, colon, or colorectal cancer. We've been coding the test as 88361 x 2 -- is that correct?

Colorado Subscriber

Answer: No, 88361 (Morphometric analysis, tumor immunohistochemistry [e.g., Her-2/neu, estrogen receptor/progesterone receptor], quantitative or semiquantitative, each antibody; using computer-assisted technology) is not the correct coding for a circulating tumor cell (CTC) blood test after Jan. 1, 2012.

Here's why: CPT 2012 adds the following two new Category III codes for a CTC in blood specimens:

• 0279T -- Cell enumeration using immunologic selection and identification in fluid specimen [e.g., circulating tumor cells in blood)
• 0280T -- ... interpretation and report.

Technical or professional: Note that one code represents the technical component of the test (0279T), and the other code represents the professional component (0280T). Make sure you bill only the part of the test your lab or pathologist performs.

That rule is different from many pathology codes that represent a "global" service," which includes both the technical and professional component in one code. For global codes, you'd need to use modifier TC (Technical component) or 26 (Professional component) if you're only billing for one part of the service. Don't use modifiers TC and 26 with new codes 0279T and 0280T.