Wiki Billing FLOW and IHC Stains

[kkonkle]

Can anyone tell me how you are handling the coding when you have a flow study and Immunohistochemical stains on same day with some of the immunostains being duplicated antibodies done on the flow study. The codes in question are
88184/88187/88189 with 88342's same day, (some repeated antibodies, some not). Thanks

 

[tomtom2]

Flow and IHC

I'm in the same boat. Should the Dr's be ordering the Flow first and then any medically necessary IHC stains afterwords? Please Help!

 

[kkonkle]

I have found additional information about this coding scenario since my original post. Per NCCI policy if it is medically reasonable and necessary, the stains may be duplicated. A statement supporting this should be included in the report to support adding a -59 modifier.

From speaking with Pathologists and reviewing their reports, typically the Flow is performed first. Either way, look for medical necessity to support duplication of staining.

 

[aland000]

flow charges and ihc

agree, i code for pathology and lab..we add -59 modifier

 

[ktr]

agree, i code for pathology and lab..we add -59 modifier

Do you use Cerner Milenium? If so how do you navigate to add a modifier. Not been able to get that answer for years.
Thank you
Kathleen

 

[roadsky40]

Add 59 modifier to the IHC as long as documentation supports that the Flow and IHC is necessary to determine the result. Usually, either IHC or the Flow did not yield a satisfactory result that leads to the other procedure. Documentation is the key, watch out for duplication process. Pay attention for IHC or Flow that yields negative result, that could be the reason why they order more study. The key is, 59 modifier should be justifiable. Assigning 59 modifier without thorough understanding it's purpose opens up potential liability.

2012 NCCI policy for states:

Medicare does not pay for duplicate testing. CPT codes 88342 (immunocytochemistry, each antibody) and 88184, 88187, 88188, 88189 (flow cytometry) should not in general be reported for the same or similar specimens. The diagnosis should be established using one of these methods. The physician may report both CPT codes if both methods are required because the initial method does not explain all the light microscopic findings. The physician may report both methods utilizing modifier 59 and document the need for both methods in the medical record.
If the abnormal cells in two or more specimens are morphologically similar and testing on one specimen by one method (88342 or 88184, 88187, 88188, 88189) establishes the diagnosis, the same or other method should not be reported on the same or similar specimen. Similar specimens would include, but are not limited to:
Revision Date (Medicare): 1/1/2012
X-12
(1) blood and bone marrow;
(2) bone marrow aspiration and bone marrow biopsy;
(3) two separate lymph nodes; or
(4) lymph node and other tissue with lymphoid infiltrate.