jdavenport02
Networker
Any insight on what Palmetto GBA posted regarding the billing of Special/IHC stains for gastric pathology?
Our pathologists are concerned that they won't be able to bill for just the H&E stain along with the appropriate tissue CPT code (i.e. 88305). From what I read, they can bill for this stain; however, if any other stains need to be performed, documentation in the report needs to support.
Am I wrong? Any insight is greatly appreciated!
________________________________________________
MolDX
Special Stains and Immunohistochemistry (IHC) Indications for Gastric Pathology (M00097)
Only the pathologist may determine the medical necessity of a special stain. The vast majority of conditions of the stomach on biopsy can be diagnosed by the use of the routine hematoxylin and eosin (H&E) stain alone. There is potential for either over-utilization or under-utilization of these ancillary special stains. In most cases it is NOT reasonable or necessary to perform 'special stains' such as alcian blue (AB) - periodic acid schiff (PAS) to determine if clinically meaningful intestinal metaplasia is present. In addition it is not usually reasonable or necessary to perform special stains or immunostains (IHC) to determine the presence of H. pylori.
Ordering special stains or immunostains prior to review of the H&E stain is not reasonable and necessary. If stains in addition to the H&E stain are needed, specific documentation to justify the need for the special stain is required in the pathology report. Although uncommon, cases that may require 'special stains' or an IHC include but are not limited to the following:
?Detection of H. pylori in an appropriate milieu when organisms are not be seen on H&E stained slides (see Batts K, et al reference)
?Evaluating an atrophic gastritis for evidence of autoimmune etiology
?Characterizing a carcinoma, lymphoma, or sarcoma
?Defining a GIST tumor
Scientific data demonstrates that the combined number of gastric biopsies requiring special stains is equal to or less than 20 percent of biopsies received and examined in a practice, laboratory, or hospital. Palmetto GBA agrees with the published data. To check utilization, Palmetto GBA encourages providers to perform a self-audit on the number of separate gastric biopsies (reported with CPT code 88305) as compared to ancillary stains (reported with CPT codes 88312, 88313, G0461, and G0462). The ancillary stain code group should be less than 20 percent of the total gastric biopsies (88305 codes) submitted.
Providers that exceed the 20 percent criteria may be subject to additional action.
Our pathologists are concerned that they won't be able to bill for just the H&E stain along with the appropriate tissue CPT code (i.e. 88305). From what I read, they can bill for this stain; however, if any other stains need to be performed, documentation in the report needs to support.
Am I wrong? Any insight is greatly appreciated!
________________________________________________
MolDX
Special Stains and Immunohistochemistry (IHC) Indications for Gastric Pathology (M00097)
Only the pathologist may determine the medical necessity of a special stain. The vast majority of conditions of the stomach on biopsy can be diagnosed by the use of the routine hematoxylin and eosin (H&E) stain alone. There is potential for either over-utilization or under-utilization of these ancillary special stains. In most cases it is NOT reasonable or necessary to perform 'special stains' such as alcian blue (AB) - periodic acid schiff (PAS) to determine if clinically meaningful intestinal metaplasia is present. In addition it is not usually reasonable or necessary to perform special stains or immunostains (IHC) to determine the presence of H. pylori.
Ordering special stains or immunostains prior to review of the H&E stain is not reasonable and necessary. If stains in addition to the H&E stain are needed, specific documentation to justify the need for the special stain is required in the pathology report. Although uncommon, cases that may require 'special stains' or an IHC include but are not limited to the following:
?Detection of H. pylori in an appropriate milieu when organisms are not be seen on H&E stained slides (see Batts K, et al reference)
?Evaluating an atrophic gastritis for evidence of autoimmune etiology
?Characterizing a carcinoma, lymphoma, or sarcoma
?Defining a GIST tumor
Scientific data demonstrates that the combined number of gastric biopsies requiring special stains is equal to or less than 20 percent of biopsies received and examined in a practice, laboratory, or hospital. Palmetto GBA agrees with the published data. To check utilization, Palmetto GBA encourages providers to perform a self-audit on the number of separate gastric biopsies (reported with CPT code 88305) as compared to ancillary stains (reported with CPT codes 88312, 88313, G0461, and G0462). The ancillary stain code group should be less than 20 percent of the total gastric biopsies (88305 codes) submitted.
Providers that exceed the 20 percent criteria may be subject to additional action.