Code 88363 (Examination and selection of retrieved archival [ie, previously diagnosed tissue(s) for molecular analysis) is an important code that was added to CPT in 2011. It gives pathologists and labs a way to charge for the work involved in selecting and preparing archived pathology material for molecular tests (KRAS mutational analysis) ordered by the treating physician after the primary case is signed out.
The descriptor for code 88363 specifically refers to “retrieved archival” tissue or tissues. Per the AMA’s Current Procedural Terminology (CPT), the definition of “archival” when referring to this code, is when the case report and slides/tissue are signed out and released to be stored. It is not Medicare’s definition of an “archived” specimen which is “older than 30 days.”
Code 88363 is reportable when the referring physician requests a molecular test on tissue from a case that has previously been completed and signed out by the pathologist. The professional work of the pathologist that is covered by code 88363 consists of:
● retrieving the archive case report and blocks/slides from storage;
● re-examining the original report and slides to determine which block(s) contains the appropriate cells to the specifications of the requested molecular test; and
● preparation of the appropriate block(s) for referral to the molecular lab whether the molecular lab is in-house or outside.
Code 88363 is reported once for each specimen retrieved. The number of molecular tests ordered or performed on the archived material does not factor in. An addendum to the original report describing the service provided and the results of the molecular studies is one way to report the service, or a separate report is acceptable.
Code 88363 is a global service according to the Medicare physician fee schedule, so modifiers TC and 26 do not apply even though the service entails both technical and professional work. It can be reported with the Outpatient Hospital place of service for reimbursement at the facility rate, or by an Independent Lab with a Medical Office or Independent Lab place of service for reimbursement at the higher non-facility rate. Per the 2013 Medicare Physician Fee Schedule, national reimbursement for code 88363 non-facility is $56.82 and facility is $19.39.
There are also certain Medicare carriers for selected states that have put Local Coverage Determinations (LCD’s) in place for this code. The LCD’s are guidelines for selected CPT codes with a list of ICD-9-CM codes that can only be reported to support medical necessity.
Other related CPT codes 88380 (Microdissection [sample preparation of microscopically identified target]; laser capture) and 88381 (………manual) are reported when a patient’s physician orders molecular analysis on an archived specimen and microdissection is done to prepare the specimen for the study. In this case, both services are reportable; however, per Medicare’s NCCI edits (National Correct Coding Initiative) code 88363 bundles into 88380/88381 and, therefore, is not eligible for payment.
Fremont, CA