Christine Posted Sun 23rd of February, 2020 07:44:01 AM
Does the documentation below support billing both CPT's 88360 and 88342 on the same specimen with the modifier XU? Supplemental Report: IHS STAINS: -ESTROGEN RECEPTOR : POSITIVE (% POSITIVE CELLS:90) -PROGESTERONE RECEPTOR: POSITVIE (%POSITIVE CELLS:80) -HER2-NEU: EQUIVOCAL (2+) (% POSITIVE CELLS,30); SEE NOTE . -KI67 : LOW (%POSITIVE CELLS:<20) - MYOEPITHELIAL CELL MARKDERS(CALPONIN,P63 AND SMOOTH MUSCLE ACTIN): NEGATIVE IN TUMOR; SUPPORTING INVASIVE CARICNOMA. - CONTROLS(INTERNAL AND EXTERNA) : APPROPRIATE. NOTE: HER 2 FISH TESTING IS PENDING , RESULTS TO FOLLOW.
SuperCoder Answered Mon 24th of February, 2020 05:48:06 AM
CPT code 88342 should be reported for each Immunohistochemistry (IHC) or immunocytochemistry (ICC), a single antibody stain procedure.
There are two codes for reporting quantitative/semi-quantitative IHC. They are codes 88360 and 88361. These two codes have only been revised to clarify that it is to be reported “per specimen” for each single antibody procedure.
As per guidelines, do not report 88360, 88361 in conjunction with 88341, 88342, or 88344 unless each procedure is for a different antibody. Therefore, if the procedures are performed on different antibodies, you can report 88360 and 88342 together. Append 59 or XU modifier with CPT code 88342.
Christine Posted Mon 24th of February, 2020 15:25:47 PM
I am not sure I understand. For example, if we have a Ki67 (88360) and an ER(88342) then they can be reported out together. If we had and ER (88342) and ER Quant (88360) then we cannot bill them together, correct? Our billing company is saying something contradictory. Which is correct? We received a response regarding the bundling issues with CPT code 88360 and 83342 when performed on the same specimen. As suspected, 83342 does bundle into 88360 in this case therefore modifier 59 would not be appropriate.
88341 - Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure)
88342 - Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure
88360 Morphometric analysis, tumor immunohistochemistry (eg, Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen, each single antibody stain procedure; manual
The NCCI bundles and includes codes 88341/88342 as components of code 88360. When performing morphometric analysis, in general codes 88341/88342 should not be unbundled for the same specimen.
The NCCI Policy Manual, Chapter 10 states:
Morphometric analysis of tumor immunohistochemistry using a multiplex antibody stain shall be reported with one unit of service of CPT code 88360 or 88361 per specimen. It shall not be reported with one or more UOS of CPT codes 88341, 88342, or 88344.
For immunohistochemistry reported as CPT codes 88360 or 88361, the unit of service is each single or multiplex antibody(s) stain procedure per specimen. If a single or multiplex antibody immunohistochemical stain procedure reported as CPT codes 88360 or 88361 is performed on multiple blocks from a surgical specimen, multiple slides from a cytologic specimen, or multiple slides from a hematologic specimen, only one unit of service shall be reported for each separate specimen. Physicians shall not report more than one unit of service for CPT codes 88360 or 88361 per specimen for an immunohistochemical multiplex antibody stain procedure even if it contains multiple separately interpretable antibodies.
SuperCoder Answered Tue 25th of February, 2020 08:23:56 AM
CPT code 88360 should be coded when quantitative or semi quantitative morphometric analysis has been performed on the different antibody. If procedure has been performed on the same antibody, cannot report this code with 88342.
Use 88342 for Qualitative IHC:- Pathologists often use the same markers in tests that provide quantitative or semiquantitative results using either manual or automated methods. These services require different codes--88360 or 88361.
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