Pathology/Lab Coding Alert

Answer: There is no restriction for using 88271-88275 (Molecular cytogenetics …) versus 88365-88368 (… in situ hybridization …) for fluorescence in situ hybridization (FISH) based on specimen type.

 

The College of American Pathologists indicates in CAP Today Dec. 2004 that “The in situ hybridization codes within the anatomic pathology section (88365-88368) are intended to be used when performed as an ancillary analysis to surgical pathology and cytopathology…[When] done as an ancillary analysis to cytogenetic studies, codes in the cytogenetic range (88271-88275) should be assigned.”

 

CMS distinguishes the codes based on the type of provider the performs the test. If a physician (MD/DO) performs the service, you should report 88365-88368 codes. If  a PhD lab scientist does the test, you should use the molecular cytogenetics codes (88271-88275). 

 

Although not identical, the standards for choosing the codes emphasized by CAP and CMS lead you to the same code choice, in practice.

 

In your example, the MD performing the service on a paraffin-embedded tissue specimen from a surgical pathology exam warrants using the 88365-88368 code family. 

 

Do this: You should choose the specific code based on whether the test is qualitative or quantitative, and whether the lab method involves manual or computer assisted quantification