Pathology/Lab Coding Alert

Question: A physician recently sent a breast tissue specimen to our pathologist for a HER-2/neu test. The report sent with the specimen shows that the physician originally took the specimen and submitted it for pathologist examination on Oct. 3, 2003. Should we report the HER-2/neu using CPT codes that are new since the specimen was first examined, and should we use Oct. 3, 2003, as the date of service?

Colorado Subscriber Answer: You should use current codes and the current date to process the HER-2/neu test for this specimen. Medicare recently finalized "date-of-service" rules to clarify that you should report services for stored specimens using the date of retrieval from the archives.  

Medicare considers a specimen stored more than 30 days to be archived. In your example, the specimen is almost two years old.
Based on whether the lab performs the quantification of the HER-2/neu probe using manual or computer-assisted techniques, you should use one of two new CPT codes to report the service: 88367, Morphometric analysis, in situ hybridization [quantitative or semi-quantitative], each probe; using computer-assisted technology; or 88368, ... manual.

Tip: In addition to defining the date of service as the date of retrieval for specimens stored more than 30 days (archived), Medicare also specifies that you should use the collection date for all other specimens.

For specimen collections that span more than 24 hours, CMS defines the date of service as the collection end-date. You can read the CMS final rule in the Feb. 25 Federal Register, available online at http://a257.g.akamaitech.net/7/257/2422/01jan20051800/edocket.access.gpo.gov/2005/pdf/05-3727.pdf.