Pathology/Lab Coding Alert

Question: Our pathologist evaluated a bone marrow biopsy and clot section from a patient diagnosed with metastatic breast carcinoma. The pathology report states, “The metastatic carcinoma is estrogen receptor (ER) positive and progesterone receptor (PR) negative. HER2/neu studies performed by immunohistochemistry show 1+ membrane stain, which is equivocal. HER2/neu analysis by FISH was attempted, but tumor was not available on deeper sections to complete this study.”

Which CPT Codes should I use to bill this case? The pathologists performed all analyses using   manual methods.


Illinois Subscriber


Answer: Use the following CPT codes to report this case:

• 88305 (Level IV--Surgical pathology, gross and microscopic examination, bone marrow, biopsy) This code describes the pathologist’s bone-marrow biopsy evaluation.

• 88305 (… cell block, any source) Report an additional 88305 for the pathologist’s examination of the cell block prepared from the clot.

• 2 x 88342 (Immunohistochemistry [including tissue immunoperoxidase], each antibody) You should use 88342 for the ER/PR stains because the report simply states “positive” or “negative,” meaning that this is a qualitative result. Because the code states, “each antibody,” you should list two units of 88342--one for estrogen receptor and one for progesterone receptor.

• 88360 (Morphometric analysis, tumor immunohistochemistry [e.g., Her-2/neu, estrogen receptor/progesterone receptor], quantitative or semiquantitative, each antibody; manual) Unlike the ER/PR results, which are qualitative, the Her-2/neu results are semiquantitative. The fact that the report states “1+ membrane stain” means that the pathologist “scores” the slide using a semiquantitative scale rather than simply noting the presence or absence of Her-2/neu antibody and giving a positive or negative qualitative report. 
 
You should not bill the Her-2/neu analysis by FISH because the pathologist did not complete the study and did not provide any diagnostic results from the attempt.