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Macrodissection

Vicki Posted Fri 23rd of August, 2013 15:59:53 PM

Should you bill '88363' and '88381-TC' together? Our pathologists retrieve specimen from archives and select cell and send to outside lab for test.

SuperCoder Answered Fri 23rd of August, 2013 17:08:45 PM

From Coding Alert:

88363 (Examination and selection of retrieved archival [i.e., previously diagnosed] tissue[s] for molecular analysis [e.g., KRAS mutational analysis]) isn't the only code that describes prep work that a pathologist might perform prior to molecular testing.

Code 88363 describes the work when a pathologist retrieves a signed-out case to select appropriate tissue for molecular analysis. Make sure you know the difference between 88363 and codes from the following two code families.

Watch 88380-88381 Bundles

Pathologists sometimes obtain target tumor cells for molecular analysis by using manual or laser capture microdissection techniques. You report the service using 88380 (Microdissection [i.e., sample preparation of microscopically identified target]; laser capture) or 88381 (... manual).

"It's conceivable that a pathologist or one of his/her associates will select archival tissue for a molecular analysis ordered by the patient's physician and then perform microdissection on the archival tissue to prepare it for the test," says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc. and publisher of the Pathology Service Coding Handbook, in The Villages, Fla.

Beware edits: Medicare's Correct Coding Initiative (CCI) bundles 88363 with 88380 or 88381. That means you shouldn't bill the codes together when the pathologist selects archive material and performs microdissection for the same molecular analysis. "It's reasonable to assume that CMS expects this bundle to apply as well to the situation where a colleague pathologist performs the microdissection, even when that's done a day or two later," advises Padget.

Do this: Bill the code that represents the most comprehensive documented service, such as 88381, which pays $184.15 versus 88363, which pays $38.05 (national non-facility total amount, conversion factor 33.9764).

Choose 88387 Family or 88363

Sometimes pathologists perform sterile macroscopic dissection to prep fresh tissue for molecular diagnostics testing. CPT provides the following two codes to capture the service:

88387 -- Macroscopic examination, dissection, and preparation of tissue for nonmicroscopic analytical studies (e.g., nucleic acid-based molecular studies); each tissue preparation (e.g., a single lymph node)
+88388 -- ... in conjunction with a touch imprint, intraoperative consultation, or frozen section, each tissue preparation (e.g., a single lymph node) (List separately in addition to code for primary procedure).
For instance: The pathologist might process a sentinel lymph node biopsy and provide distinct sterile macroscopic examination and sectioning for T or B clonality evaluation, according to Sophia Hauxwell, MT-ASCP, laboratory scientist in the University of Nebraska Medical Center Molecular Diagnostics Laboratory in Omaha.

Distinguish 88363: When preparing a specimen for molecular studies, 88387 and +88388 refer to specific pathologist macroscopic work that takes place before the pathologist performs the microscopic examination (such as 88307, Level V -- Surgical pathology, gross and microscopicexamination). In contrast, 88363 takes place on archival tissue after the pathologist has completed the surgical pathology service and signed out the case.

I hope this helps!

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