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88342 per specimen

Patricia Posted Tue 17th of January, 2012 15:52:45 PM

Does 88342 per specimen pretain to all carriers or medicare only?

SuperCoder Answered Wed 18th of January, 2012 05:54:09 AM

Thought it better to submit the details on 88342 billing guideline:
This code describes a qualitative tissue IHC stain — 88342. Pathologists use these qualitative antibody stains as “markers” for the presence or absence of specific antigens used to identify tumor type. The pathologist interprets these stains as “yes,” the antigen is present, or “no,” the antigen is not present, or he may qualify the results based on stain intensity without quantifying degree of staining.
Know unit of service: The code definition states “each antibody,” so you should report one unit of 88342 for each antibody stain that the pathologist examines for a specific tissue specimen. Pathologists often evaluate a series of IHC antibody stains to assist in tumor typing, and you should list each stain as one unit of 88342.
Lesson: Only use 88342 to describe a qualitative test, such as an estrogen receptor/progesterone receptor (ER/PR) stain that the pathologist examines to identify the presence or absence of ER/PR in a breast tissue biopsy.
If the pathologist provides a quantitative/semiquantitative ER/PR evaluation, don’t use 88342.

Patricia Posted Wed 18th of January, 2012 13:55:43 PM

Thanks for the billing guideline information. What I really need know does this rule apply only to medicare/medicaid or to all carriers. I am thinking this rule applies to all carriers- bill each antibody stain per tissue specimen and not by the number of blocks the stain was performed on(exp-breast bx- CD34 done on blocks-1A-1D- carrier is Medcost- would you bill 88342 x 1 and not 88342 x 4)?

Jared Answered Wed 18th of January, 2012 17:01:12 PM

It is "per specimen, per stain". I the above cell blocks were all from the same specimen, it would be 88142 with one unit only. In surgical pathology, the unit is always the specimen. That is CPT definition, and applies to all carriers. How they interpret that is sometimes not the way you or I would interpret it. Medicare has a limit of the number of units you can bill for 88342, denying for MUE, but you can never find in writing what that number is, nor can you get anyone on the phone to tell you.

Wendy Answered Sat 25th of February, 2012 01:28:39 AM

Patricia, it looks like everyone has skirted your question. But this is the first time I've read it. As of January 1, 2012, CMS has returned to their previous directive of "per specimen, per stain." However, there has been no signal (that I am aware of) from other carriers that they are following suit. If the carrier is not Medicare, I code 88342 (or 88360) per stain, per block. However, that may change if they begin to deny the charges.

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