Pathology/Lab Coding Alert

Question: We are still dealing with getting paid for some IHC staining tests done in from 2014 from Medicare. Some patients are billed for G0461 x5. Medicare will pay for G0461-26 and G0461-26-59, but denies the remaining 3. I have done redeterminations with G0461-26-59-76, with a new line for the remaining three codes and they paid one more. What modifiers do we use to get multiples paid, such as this code, and 88305?

Iowa Subscriber

Answer: Payers often establish their own expectations for how you should report multiple services of the same test. For instance, many payers accept units (such as 88305x3) while others want you to place each code on a separate claim line, using a modifier on the second and subsequent claim lines such as 59 (Distinct procedural service) or 76 (Repeat procedure or service by same physician or other qualified health care professional). Under no circumstances would you identify repeat/distinct services using modifier 26 (Professional component).

However, your denial problem may not be related to modifier use at all. The correct use of G0461 (Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain) involves reporting the code just once for a single specimen. If the pathologist performs additional immunohistochemistry (IHC) on the same specimen, you should not code additional units of G0461, but instead report G0462 (…each additional single or multiplex antibody stain [list separately in addition to code for primary procedure]) for each additional IHC stain on the same specimen.

You mentioned that these are redeterminations from 2014. CMS has since deleted codes G0461 and G0462, because Medicare now accepts the CPT^® 2015 codes for these services. Billing for multiple IHC stains on a single specimen would follow a similar pattern using the following two codes:

• 88342 — Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure 

• +88341 — … each additional single antibody stain procedure (List separately in addition to code for primary procedure)