Pathology/Lab Coding Alert

Update Your ISH/FISH Coding - Here's How

- Published on Tue, Feb 01, 2005

CPT Codes 2005 expands 88365-88368

CPT 2005 erased the line in the sand - you should no longer use 88365 only for tissue ISH. Removing the word ""tissue"" from the code definition allows you to report this code for cytology specimens as well.

Nor should you have any more problems reporting ISH tests with a morphometric analysis component (quantitation) because CPT 2005 added two new codes for this service following 88365 (In situ hybridization [e.g. FISH] each probe). The codes distinguish between automated (88367 Morphometric analysis in situ hybridization [quantitative or semi-quantitative] each probe; using computer-assisted technology) and manual (88368 ... manual) ISH quantification.

88365-88368 Now Include Cytology

Prior to 2005 CPT 88365 (Tissue in situ hybridization interpretation and report) designated tissue as the specimen. The description left coders with a dilemma about how to report non-tissue ISH such as cervical cytology specimens evaluated for the presence of human papillomavirus (HPV) using ISH technique. Some experts advised reporting 88365 for these exfoliated-cell samples even though the specimen did not fit the ""tissue"" definition.
The 2005 CPT code description ends the debate. ""Based on the new 88365 definition you can report a qualitative ISH test that the lab performs on a cytology specimen using this code "" says Dennis Padget MBA CPA FHFMA president of DLPadget Enterprises Inc. a pathology business publishing company in Simpsonville Ky. ""Dropping the word 'tissue' from the 88365 descriptor broadened its usage "" he says.

Key: Like 88365 CPT 88367 and 88368 for morphometric analysis using ISH do not designate tissue as the specimen type so you can also report them with cytology-type specimens when applicable.

Use Different Codes for Qualitative/Quantitative

CPT 2005 solves a coding dilemma by creating 88367 and 88368 for ISH morphometric analysis - a quantitative or semiquantitative evaluation. Prior to the addition of these codes you had to use 88365 to report either qualitative or quantitative ISH testing. Coders used to report quantitative ISH as 88365 plus 88358 (Morphometric analysis; tumor) but a National Correct Coding Initiative (NCCI) edit implemented in  January 2004 disallowed that code combination for the same specimen.

Don't miss: Adding 88367 and 88368 for quantitative or semiquantitative ISH leaves 88365 for qualitative ISH testing alone. The text note following 88365 - Do not report 88365 in conjunction with 88367 88368 for the same probe - clarifies that the new morphometric analysis codes include any qualitative assessment. For a single specimen you should not report 88365 in addition to 88367 or 88368 says Laura Edgeworth HTL CPC coding and audit specialist with Pathology Service Associates LLC (PSA) in Florence S.C.

Distinguish Computer From Manual Morphometric

Once you've determined if the ISH test is qualitative (88365) or quantitative you have [...]

Pathology/Lab Coding Alert
Issue - Feb, 2005
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