Pathology/Lab Coding Alert

Question: Our lab performs a HER-2/neu antibody test on paraffin embedded breast tissue and scores the slides for staining using an Aperio digital pathology system. The scoring possibilities under this system are negative (0 or 1+), equivocal (2+), or strongly positive (3+). The scores are based on counting/estimating whether membrane staining occurs in more than 10 percent of invasive tumor cells, and how intense the membrane staining is. If the test results are “0” (negative), should we report 88342 because there are no tumor cells present?  

California Subscriber

Answer: No, the code doesn’t depend on the test results; it depends on which test you perform. The lab method you describe involves using an automated system with a numeric scoring system that includes a “count” and approximation of percentage and intensity of cell staining. That is a semi-quantitative test, not a qualitative test. 

The most accurate code for the test you describe is 88361 (Morphometric analysis, tumor immunohistochemistry [e.g., Her-2/neu, estrogen receptor/progesterone receptor], quantitative or semiquantitative, each antibody; using computer-assisted technology). 

If the lab used a manual system that involved having a pathologist count cells and score the slide, you should report 88360 (… manual).

The code you mentioned is for a qualitative immunohistochemistry stain for HER-2/neu (88342, Immunohistochemistry or immunocytochemistry, each separately identifiable antibody per block, cytologic preparation, or hematologic smear; first separately identifiable antibody per slide). You should not choose this code just because the test results are negative with no tumor cell staining.