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2015 Coding Examples for Qualitative/Quantitative IHC, Morphometric Analysis and FISH/ISH

CODES 88341, 88342 AND 88344
Key highlights for qualitative IHC:
• There are now three codes for reporting a qualitative IHC stain
• Code 88343 has been deleted for 2015
• “G” codes G0461 and G0462 will no longer be reported to CMS
• For 2015 IHC stains will no longer be reported per block
• Codes 88342 and 88341 will be for reporting a single antibody stain procedure
• Code 88344 will be used to report a multiplex antibody stain procedure
(e.g., PIN-4, ADH-5, Uro-3 Triple stain)
• Code 88344 can only be reported when the two or three different antibodies used show precisely which are staining positive and which are not
• When multiple separately identifiable antibodies are applied to the same specimen [ie, multiplex antibody stain procedure], use one unit of 88344
• When multiple antibodies are applied to the same slide that are not separately identifiable [eg, antibody cocktails], use 88342, unless an additional separately identifiable antibody is also used, then use 88344

Coding Examples
88342 Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure 
           +88341   each additional single antibody stain procedure
88344   each multiplex antibody stain procedure

Examples:
1) One Specimen
IHC S100 on block A1 and A2 88342
IHC Melan-A   88341

2) One Specimen
IHC primary stain CK5  88342
IHC primary stain p53  88341
IHC primary stain SMMC  88341

3) Two Specimens
Specimen 1
IHC primary stain E-Cadherin 88342
IHC primary stain HMWCK 88341
Specimen 2 
IHC primary stain ADH-5 88344

4) Six Prostate Specimens
Specimen B-IHC PIN-4   88344
Specimen E-IHC PIN-4  88344
Specimen F-IHC PIN-4  88344

CODES 88360 AND 88361
There are still only two codes listed in 2015 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. There is no multiplex quantitative/semi-quantitative code as there is for a qualitative IHC.  Per CPT there are two parenthetical guidelines:
• Do not report 88360,88361 in conjunction with 88341, 88342, or 88344 unless each procedure is for a different antibody
• Morphometric analysis of a multiplex antibody stain should be reported with one unit of 88360 or 88361, per specimen

88360     Morphometric analysis, tumor immunohistochemistry (eg, Her-2/neu, estrogen, progesterone receptor), quantitative or semi-quantitative, per specimen, each single antibody stain  procedure; manual
               88361  using computer-assisted technology

FISH CODES
In situ hybridization for 2015 has been revised and expanded.  There will be three separate code families and each family will identify:
• The initial single probe stain procedure
• Each additional single probe stain procedure
• Each multiplex probe stain procedure

Guidelines for reporting FISH
• The definition of “procedure” is not the probe itself as many ISH procedures are two or more probes
• The definition of “multiplex” is an ISH procedure that requires two or more probes that results to a single conclusion
• Do not use qualitative and quantitative codes for the same staining procedure
• Single probe stain procedures are reported “per specimen”
• Report each unduplicated single probe procedure with the appropriate code (88365, 88364)
• Multiplex probe stain procedures are reported “per specimen” (88366)
• Report each unduplicated multiplex probe stain procedure with the appropriate code

First Family of Codes (qualitative)
88365 In situ hybridization (eg, FISH), per specimen; initial single probe stain procedure
+88364  each additional single probe stain procedure
88366  each multiplex probe stain procedure

Case Examples
1) EBER ISH      88365

2) EBER ISH    88365
    Cytomegalovirus ISH   88364

3) IGH@BCL2 translocation using DNA    
    probes for both IGH@ and BCL2 88366

Second Family of Codes (semi-quantitative/quantitative; computer-assisted)
88367 Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen, initial single probe stain procedure 
           +88373 each additional single probe stain procedure
88374  each multiplex probe stain procedure

Examples
1) Kappa ISH/computer-assisted  88367
 
2) Kappa ISH/computer-assisted  88367
     Lambda ISH/computer-assisted 88373

3) Her2/CEP17 ISH/computer-assisted 88374

Third Family of Codes (semi-quantitative/quantitative; manual)
88368 Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual per specimen, initial single probe stain procedure
           +88369 each additional single probe stain procedure
88377  each multiplex probe stain procedure

Examples
1) Kappa ISH/manual   88368
 
2) Kappa ISH/manual   88368
    Lambda ISH/manual   88369

3) Her2/CEP17 ISH/manual  88377

Documentation is critical for the correct CPT code to be assigned.  Not only for a coder to assign the appropriate code, but to support your code choice to an insurance carrier or in a carrier audit.  Key words that describe the test so it can be translated to the CPT nomenclature would be best.  Document the following:

• Specimen tested
• What the test is for
• Test method
• Qualitative or quantitative/semi-quantitative
• Manually or computer-assisted
• Each probe stain procedure single or multiplex
 
As a reminder, clients who submit their CPT codes electronically may want to check their client master fee schedule to delete 88343 and add any new codes that may apply to your practice.  For any clients that use a billing slip be sure to review and update for 2015.

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