Pathology/Lab Coding Alert

Question: We received a paraffin block from an outside lab with a request to run repeat receptor studies (ER, PR, and HER2-neu). We also received pathology reports indicating that the patient has invasive ductal carcinoma. We prepared the block, ran the receptor studies, and reported the results. Our pathologist did not provide a diagnosis based on the results. Can we bill 88323 in addition to the stains we performed?
Texas Subscriber

Answer: No, the case you’ve described does not warrant reporting 88323 (Consultation and report on referred material requiring preparation of slides) in addition to the receptor studies.

You provide no evidence that a referring physician requested that your pathologist review the case and offer an opinion. You also provide no evidence that the pathologist evaluated the case and provided an opinion on the diagnosis. You should bill only the receptor studies.

Which codes you use to bill the ER, PR, and HER2-neu tests depends on the lab method you use. For qualitative stains, report 88342 (Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure) and two units of +88341 (… each additional single antibody stain procedure [List separately in addition to code for primary procedure]).

Quantitative is different: If the lab performs a quantitative or semi-quantitative test for these receptor studies, you should select the appropriate codes based on whether the test is manual or uses computer assisted technology for the quantification:

• 88360 — Morphometric analysis, tumor immunohistochemistry (egg, Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen, each single antibody stain procedure; manual
  

• 88361 — … using computer-assisted technology.
  

Regardless of which code you choose, you should report one unit for each of the single antibodies. That’s three units of 88360 or 88361 for ER, PR, and HER2-neu receptor studies on a single specimen.