Lupita1983
New
Good morning,
I am trying to comprehend when it's appropriate to code for 88360 vs 88342 for stains such as ER, PR, Ki-67, PTEN, BCL-2 and SDHB when done in-house and sent out as Tech only. I have seen someone else ask recently about this same question but I would like to give a couple of scenarios for my better understanding.
Case 1:
Comment: The morphology and immunoprofie supports high grade neuroendocrine carcinoma, however Ki-67 (proliferation marker) is in progress.
Addendum: Ki-67: Very high ( >90%) proliferation indes. These results supports small cell carcinoma.
Question: Can this Ki-67 be coded as 88360 because it has the percentage or would it be a normal 88342/88341?
Case 2:
Comment: The following immunohistochemical stains were performed with appropriate positive and negative controls:
CD10: Positive in uterine stromal cells
ER: Positive
p53: Wild type
PTEN: Retained
BCL-2: Retained
PAX2: Lost (patchy)
These results supports the final diagnosis.
PTEN, BCL-2 and PAX2 stains were performed at ********* Laboratories and interpreted at ************* Department of Anatomic Pathology.
Question: I know the ER stain in this case would be 88342/88341 but what about the three stains done at technical component done at outside lab and interpreted by our path? When we receive tech stains from the outside laboratory, we receive a statement of what we are receving (test performed) and what they are billing. The PTEN, BCL-2 and PAX2 stains are always billed as 88360 (outside statement) but when I see this report, I don't see percentages (quantitative) so I would code as 88342/88341. Am I right to do this or should I be coding what the outside lab is coding? What is the difference between qualitative and quantitative? To me, qualitative is a simple positive/negative and quantitative is percentage.
Case 3:
DOS: 4/11 and completed 4/15
The following immunohistochemical stains were performed with appropriate positive and negative controls:
The tumor cells are positive for Vimentin, ER, CK7 (patchy). P53 is wild type, negative for CK 20.
P16 is patchy and weak. These results supports the final diagnosis (Endometrial endometrioid adenocarcinoma)
5/03 - Addendum:
ER: Positive
- Tumor stained: 90%
- Intensity: strong
PgR: Positive
- Tumor stained: 80%
- Intensity: strong
Question: This case was billed immediately after completion but then two weeks later the oncologist came back and asked ut to perform the ER/PR. Initially, the ER stain was billed as 88342/88341 but when charges were corrected, I removed 1 stain from 88341 and billed 88360 x 2. Did I do this correctly or was I able to leave the IHC stain charge? Because to my understanding, the 88360 is like a bundled code (IHC - Qualitative & percentage - Quantitative) Do I understand correctly?
Please know that I really appreciate the time you are taking to review my questions. Thank you
I am trying to comprehend when it's appropriate to code for 88360 vs 88342 for stains such as ER, PR, Ki-67, PTEN, BCL-2 and SDHB when done in-house and sent out as Tech only. I have seen someone else ask recently about this same question but I would like to give a couple of scenarios for my better understanding.
Case 1:
Comment: The morphology and immunoprofie supports high grade neuroendocrine carcinoma, however Ki-67 (proliferation marker) is in progress.
Addendum: Ki-67: Very high ( >90%) proliferation indes. These results supports small cell carcinoma.
Question: Can this Ki-67 be coded as 88360 because it has the percentage or would it be a normal 88342/88341?
Case 2:
Comment: The following immunohistochemical stains were performed with appropriate positive and negative controls:
CD10: Positive in uterine stromal cells
ER: Positive
p53: Wild type
PTEN: Retained
BCL-2: Retained
PAX2: Lost (patchy)
These results supports the final diagnosis.
PTEN, BCL-2 and PAX2 stains were performed at ********* Laboratories and interpreted at ************* Department of Anatomic Pathology.
Question: I know the ER stain in this case would be 88342/88341 but what about the three stains done at technical component done at outside lab and interpreted by our path? When we receive tech stains from the outside laboratory, we receive a statement of what we are receving (test performed) and what they are billing. The PTEN, BCL-2 and PAX2 stains are always billed as 88360 (outside statement) but when I see this report, I don't see percentages (quantitative) so I would code as 88342/88341. Am I right to do this or should I be coding what the outside lab is coding? What is the difference between qualitative and quantitative? To me, qualitative is a simple positive/negative and quantitative is percentage.
Case 3:
DOS: 4/11 and completed 4/15
The following immunohistochemical stains were performed with appropriate positive and negative controls:
The tumor cells are positive for Vimentin, ER, CK7 (patchy). P53 is wild type, negative for CK 20.
P16 is patchy and weak. These results supports the final diagnosis (Endometrial endometrioid adenocarcinoma)
5/03 - Addendum:
ER: Positive
- Tumor stained: 90%
- Intensity: strong
PgR: Positive
- Tumor stained: 80%
- Intensity: strong
Question: This case was billed immediately after completion but then two weeks later the oncologist came back and asked ut to perform the ER/PR. Initially, the ER stain was billed as 88342/88341 but when charges were corrected, I removed 1 stain from 88341 and billed 88360 x 2. Did I do this correctly or was I able to leave the IHC stain charge? Because to my understanding, the 88360 is like a bundled code (IHC - Qualitative & percentage - Quantitative) Do I understand correctly?
Please know that I really appreciate the time you are taking to review my questions. Thank you