Pathology/Lab Coding Alert

Question: We’re staining breast specimens with ER, PR, Her-2/neu, and Ki67. Should I code each stain separately per specimen, and should I use 88342/+88341 or 88360?

Illinois subscriber

Answer: The “stains” you describe are immunohistochemistry, so you should bill one unit of each stain per single specimen regardless of the number of tissue blocks. That is different from some special stains, which you can bill per block.

Whether you use the 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)) or 88360 (Morphometric analysis, tumor immunohistochemistry (eg, Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen, each single antibody stain procedure; manual) depends on the details of how the lab carries out the analysis.

Tip: As a coder, you can tell from the report whether the procedure is a qualitative or quantitative/semiquantitative based on how the pathologist reports the findings. If the report states “positive” or “negative” for each stain, you should report 88342 and +88341 x 2. If the report lists some value indicating how extensive the staining is, such as “ER labels 30 percent of tumor cells,” you should report the service as 88360 x 4.