Pathology/Lab Coding Alert

 Question: We performed manual morphometric Her-2/neu, ER and PR on bilateral breast biopsy specimens -quot; should we code 88360 x 3 or 88360 x 6?
Ohio Subscriber

 Answer: You have two specimens in your example -quot; a distinct biopsy from each breast. You should list immunohistochemistry (IHC) tests per antibody for each specimen.
 The case involves three antibodies -quot; Her-2/neu, estrogen receptor (ER) and progesterone receptor (PR).
 Based on CPT definitions, the correct code for the manual tumor morphometry IHC tests you describe is 88360 (Morphometric analysis, tumor immunohistochemistry [e.g., Her-2/neu, estrogen receptor/progesterone receptor], quantitative or semiquantitative, each antibody; manual).
 If you used an automated assessment, you would instead report 88361 (- using computer-assisted technology).
 Based on your description, the correct coding for the case would be 88360 x 6 for each of three IHC tests on each of two specimens.
 Caution: If Medicare is the payer, you may have a problem reporting 88360 for some semiquantitative scoring methods that involve listing the results as a numeric score such as 0, 1+, 2+, etc. Based on the National Correct Coding Initiative Policy Manual, CMS expects that -immunohistochemistry reported with qualitative grading such as 1+ to 4+ should be reported as 88342.-
 CPT reserves 88342 (Immunohistochemistry [including tissue immunoperoxidase], each antibody) for qualitative tests as opposed to 88360 and 88361, which are for semiquantitative or quantitative IHC. Although many scoring systems such as 1+ to 4+ involve a semiquantitative measure, you should follow your carrier's direction and use 88342 when required.

 -quot; Reader Questions and You Be the Coder were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctors- Anatomic Pathology Services in Jonesboro, Ark.