Pathology/Lab Coding Alert

Follow payer rules for CPT 88361 If you're reporting 88361 to Medicare when your pathologist conducts tumor morphometry on immunohistochemistry (IHC)-stained cells, you shouldn't be - even though CPT says you can. New in 2004, code 88361 (Morphometric analysis; tumor immunohistochemistry [e.g., Her-2/neu, estrogen receptor/progesterone receptor], quantitative or semiquanti-tative) doesn't distinguish between manual and automated analysis methods. But CMS does, so you'll have to follow its rules for Medicare and any other payers that concur. Always Use 88361 for Automated IHC Tumor Morphometry When your lab uses automated microscopy and image processing to quantify IHC-stained tissue, report 88361. "There's no doubt that automated systems such as ChromaVision warrant using this new code," says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc., a pathology business publishing company in Simpsonville, Ky.

Coding example: The lab stains breast tissue slides with an estrogen receptor (ER) IHC stain. Using ChromaVision Automated Cellular Imaging System (ACIS), the pathologist selects areas for precise analysis, and the computerized system uses stain intensity analysis and object counting to establish precise percentages of ER-stained nuclei.

New way: You should report 88361 for the professional and technical components of the IHC-based tumor morphometry procedure in this instance. Old way: Before CPT 2004 added 88361, pathologists and labs had reported this service using 88342 (Immunohistochemistry [including tissue immunoperoxidase], each antibody) for the IHC stain and 88358 (Morphometric analysis; tumor [e.g., DNA ploidy]) for the morphometric analysis. (CPT 2004 added the DNAploidy example to 88358.) But a National Correct Coding Initiative (NCCI) edit in April 2003 prohibited reporting 88342 and 88358 together, leaving pathologists no way to capture the service -- until CPT 2004 introduced 88361. Use 88361 or 88342 for Manual IHC Tumor Morphometry How should you code when your lab performs an IHC stain for tumor DNA determination, then the pathologist counts stained nuclei for a percent positivity estimate or "scores" the slides using a system such as 0, 1+, 2+, 3+ for Her/2-neu? These tests are quantitative or semiquantitative analyses, which fit the 88361 code definition. Problem: CMS interprets 88361 more narrowly than its definition. "Although CPT does not distinguish between manual methods such as the pathologist's visual count and automated methods such as ChromaVision, CMS has stated that we cannot use 88361 to describe the manual services," Padget says.

Specifically, CMS states in the NCCI policy manual: "CPT code 88361 should not be used to report any service other than quantitative immunocytochemistry by digital cellular imaging. Digital cellular imaging includes computer software analysis of stained microscopic slides." You can access the manual on the Internet at http://www.cms.hhs.gov/physicians/cciedits/chap10.pdf. Do this: Instead of 88361, you should use 88342 to report manual IHC tumor morphometry, at least to [...]