Pathology/Lab Coding Alert

Question: When our lab does Her-2/neu testing for a breast biopsy specimen sent to us by the pathologist who performed the surgical pathology examination, we report 88367 for the test. If we prepare an H&E slide from a paraffin block to evaluate tumor burden as part of the Her-2/neu study, what CPT code can we use?

Tennessee Subscriber

Answer: You shouldn't separately code for preparing a hematoxylin and eosin (H&E) slide from a paraffin block as part of the Her-2/neu evaluation.

The code for the tumor in situ hybridization (ISH) includes all the steps involved in the morphometric analysis. That means the code you mentioned -- 88367 (Morphometric analysis, in situ hybridization [quantitative or semi-quantitative], each probe; using computer-assisted technology) -- includes the specimen manipulation and slide preparation.

The pathologist who sends you the breast biopsy has already prepared and examined H&E slides from the tissue and is not requesting a consultation. Rather, the pathologist is requesting additional testing (Her-2/neu), and that is all you should bill for.

Watch units: Because the unit of service for 88367 is "each probe," you may be able to report multiple units. For instance, if you test for FISH amplification based on two different probes (such as Her-2/neu and CEP-17), you should report 88367 x 2.

Manual FISH is different: If you manually "count" the slide rather than using a computer assisted technology to produce the quantitative or semi-quantitative result, you should not report 88367. Instead, you should use 88368 (- manual).