Pathology/Lab Coding Alert

Question: We perform FISH, and we’re wondering how to bill when we have already probed the specimen and the ordering physician calls and cancels the test. Can we at least bill 88271 to commercial payers for the probes?

Similarly, can we bill if the physician orders a FISH ALK, but when the specimen is set up and probed, the result is "insufficient specimen: number of hybridized cells too low to adequately perform test?"

Tennessee Subscriber

Answer: Billing for the FISH test when the ordering physician cancels the test versus when the number of hybridized cells is too low for definitive diagnosis are two different matters with distinct recommendations as follows:

1. If the physician cancels the test after you’ve already performed it, you’re dealing with an issue of business practices. You could establish a policy with your clients that orders are not revocable once you’ve performed the test, and that you will report the results to the ordering physician and file for reimbursement with payers based on the physician order.

2. If a test such as FISH ALK (for specific gene rearrangement) results in scant hybridized cells that don’t allow for differential diagnosis, you can still bill for the test, according to Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc. and publisher of the Pathology Service Coding Handbook, in The Villages, Fla. You may bill the applicable technical codes, such as 88271(Molecular cytogenetics; DNA probe, each [e.g., FISH]) times the number of probes and 88274 (Molecular cytogenetics; interphase in situ hybridization, analyze 25-99 cells), if performed, based on advice from the AMA CPT Information Services unit.

It is appropriate to bill for tests that your lab performs and services that your pathologist provides and documents, even if the procedures don’t result in a definitive diagnosis. The only exception would be a situation where you have reason to believe prior to performing the test that it may fail (for example, reagent or probe kit is out of date; H&E exam confirms scanty tumor cells).