BlakeCarswell82
Guru
Has there been an update to the 88343 addition to the 2014 book? Has MCR accepted this CPT code per slide / block?
Here is a summary of changes from CAP: http://www.cap.org/apps/cap.portal?...index.html&_state=maximized&_pageLabel=cntvwr
I can't post Padget's document here because of copyright. I can summarize parts of his discussion.
As of Jan 1, 2014, 88342 and newly created 88343 will not be valid for Medicare. Medicare has instead created codes G0461 and G0462.
For non-Medicare patients, pending any restrictions from specific payors, we will continue to use 88342 and new code 88343.
88342 Immunohistochemistry or immunocytochemistry, each separately identifiable antibody per block, cytologic preparation, or hematologic smear; first separately identifiable antibody per slide.
88343 (add-on code must be used with 88342) each additional separately identifiable antibody per slide (List separately in addition to code for primary procedure)
Note "per block" as a change from "per specimen." Also note "per slide" in reference to cocktails or multiplex IHC stains (e.g. PIN-4). Thus, for non-Medicare patients, the only time we will use 88343 is with cocktails. Instead of reporting 88342 X 3 for one block of a PIN-4, we will report 88342, 88343 X 2.
The new Medicare codes are:
G0461 Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain)
G0462 Immunohistochemistry or immunocytochemistry, per specimen; each additional single or multiplex antibody stain (List separately in addition to code for primary procedure).
Note "per specimen." Also note that it says "first single" OR multiplex stain. That means the PIN-4 will be coded G0146 X 1.
How we code to Medicare non-multiplex stains will change. For example, ER, PR, Her-2 will now be coded G0461 X 1, G0462 X 2.
Padget also states the reporting per specimen rather than block applies to Medicare, Tricare and Medicaid, but it is not clear to me whether we should use 88342/88343 or the G-codes with Tricare and Medicaid.
Padget also discusses the changes in prostate biopsy coding, summarized here from the CAP web site: "In its decision, CMS established new G codes (G0416-G0419) which will apply to all prostate biopsies (regardless of surgical technique) when 10 or more specimens are reviewed. Increased scrutiny in the reporting of multiple prostate biopsy specimens led to this policy change. Prostate biopsies with fewer than 10 specimens should be billed using CPT code 88305." Note the change: regardless of surgical technique - not just saturation biopsies.