Pathology/Lab Coding Alert
Unravel IHC Block, Specimen Question
Question: How many immunohistochemistry stains should you charge for this case: two breast tissue blocks labeled A1 and A2, each stained for ER/PR (qualitative); two sentinel lymph nodes in blocks B1, B2; and C1, C2, C3 processed for a sentinel node protocol cytokeratin stain?
Maine Subscriber
Answer: For the breast specimen, report 88342 (Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure) for estrogen receptor (ER) immunohistochemistry (IHC) stain. You should also report +88341 (… each additional single antibody stain procedure [List separately in addition to code for primary procedure]) for the progesterone receptor (PR), which is the second unique IHC stain on the same specimen. Although you have two blocks, the codes clearly state “per specimen,” so you should not report additional stain units for the two blocks.
For the sentinel lymph nodes, you should report 88342 x 2. Each sentinel node represents a unique specimen, so you should code the cytokeratin (which is an IHC stain) once for each specimen as the initial (and only) IHC stain on that specimen. Again, you should not report additional stain units for multiple specimen blocks because 88342 defines the specimen as the unit of service.
Caution: Although CPT® does not bundle sentinel lymph nodes with breast tissue, you do have to bundle regional lymph nodes with a mastectomy specimen. The documentation must clearly identify the lymph nodes as sentinel nodes to justify separate reporting.
Bottom line: The given scenario warrants reporting 88342 x 3 and +88341.
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