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Multiple Charges for Combination Stains

Nellie Posted Wed 04th of August, 2010 09:00:53 AM

'88342' Here is the problem: The Rep selling stains is pushing our tech to use a combination staining process on prostate specimens. The combination is K903/p63/P504s (three separate antibodies) Can we charge for each antibody? I have been told by the tech that K903 stains Nuclei (brown)/P63 stains membrane (brown) and P504s stains cytoplasm (red). She is being pressured by the Rep to use this combination. Any help on this.

SuperCoder Answered Wed 04th of August, 2010 16:03:35 PM

I turned to Pathology Coding Alert for help. This RQ covers 2 of the stains you mention.

Bill Immunostains Per Antibody

Question: Should we bill a prostate triple stain as 88342 or 88342 x 3?

Answer: You should list the service as 88342 x 3.

Reasoning: The unit of service for 88342 immunostains is the “antibody,” and the prostate triple stain (also called PIN4) contains three antibodies. For instance the stain typically uses p504S (also called AMCAR), p63, and CK903 (a highmolecular weight cytokeratin). Each of the three stains provides unique diagnostic information, as opposed to “mixing” to form a single diagnostic entity.

For instance: The p504 stains cytoplasm red in prostate adenocarcinoma, while p63 stains basal cell nuclei brown in benign prostate glands or prostatic intraepithelial neoplasia (PIN). The high molecular weight cytokeratin also helps identify basal cells in benign and PIN specimens by staining the cytoplasm brown.

Best documentation: To support reporting 88342 x 3, the pathologist should mention the diagnostic contribution of each stain in the pathology report. Doing so makes clear that the three stains contribute individually to the diagnosis.

Code per block for Medicare: Although CPT stipulates that the unit of service for surgical pathology is the specimen, Medicare’s Correct Coding Initiative (CCI) Policy Manual version 15.3 (effective Oct. 1, 2009) states that the unit of service for 88342 is the block. If it is medically reasonable and necessary for the pathologist to examine the PIN4 stain on more than one prostate biopsy specimen or block, you should report 88342 x 3 for each specimen or block.

I'll check with the editor, Ellen Garver, on the 3rd stain you mention.

Jen Godreau, CPC, CPEDC
Content Director,

SuperCoder Answered Thu 05th of August, 2010 12:16:43 PM

Ellen confirmed that the vendor is correct: You can charge 3 stains.

Here's what Ellen said:
Yes, the third stain would be another unit. I believe it’s actually the same stain as the reader question (cytokeratin 903 vs. keratin 903) – the nomenclature for these stains is not terribly consistent. In any event, the principle is that you can code separately for each stain in a combination stain as long as each one provides distinct diagnostic information.

Jen Godreau, CPC, CPEDC

Deyna Answered Tue 07th of September, 2010 08:11:50 AM

We just started billing these in our office... the pathologist wants to know if we can bill for the controls? if so how? and how, or are they billed if we are also billing for the FISH (88368)?
right now we are billing for these :
88342 x however many indicated

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