Pathology/Lab Coding Alert

Expect denials if you ignore new CCI 15.1 bundles.

If your lab performs tissue in situ hybridization (ISH) such as Her-2/neu, you cant separately charge for microdissection tissue prep.

Thats according to the latest version of the Correct Coding Initiative (CCI), effective April 1. Well help you get ready for all 13 new microdissection edit pairs that could impact your lab billing.

Master Microdissection

CPT lists two microdissection codes that are the subject of new CCI edits:

" 88380 -- Microdissection (i.e., sample preparation of microscopically identified target); laser capture

" 88381 -- & manual.

Microdissection is a method for isolating a small group of cells from tissue sections, explains William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

The procedure results in homogenous tumor cell samples that can improve the accuracy of sensitive molecular studies, such as polymerase chain reaction (PCR) or other amplification techniques.

Common adjunct pathology procedures such as tumor immunohistochemistry (IHC) and tissue in situhybridization (ISH) dont typically require microdissection techniques to prepare the tissue for analysis,says R.M. Stainton Jr., MD, president of Doctors Anatomic Pathology Services in Jonesboro, Ark.

Limit Microdissection to Separate Specimen

CCI 15.1 bundles the following codes with 88380 and/or 88381 for a total of 13 new edit pairs:

" 88355 -- Morphometric analysis; skeletal muscle

" 88356 --& nerve

" 88358 -- & tumor (e.g., DNA ploidy)

" 88360 -- Morphometric analysis, tumor immunohistochemistry (e.g., Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, each antibody; manual

" 88361 -- & using computer-assisted technology

" 88362 -- Nerve teasing preparations

" 88367 -- Morphometric analysis, in situhybridization (quantitative or semi-quantitatiave) each probe; using computer-assisted technology

" 88368 --& manual.

Although microdissection is a sample preparation technique for some procedures, particularly molecular studies that require target nucleic acid sequences, the CCI edits seem to indicate that the bundled codes dont require that level of tissue preparation, Dettwyler says.

Way out: If you perform a test such as Her-2/neu (88360 or 88361) and also perform a microdissection to extract tumor cells for a more specific molecular study, you can override the edit pair by appending modifier 59 (Distinct procedural service) to the column 2 (Her-2/neu) code.