CCI Policy Manual: 88342, 88360-88361: Report IHC for each Specimen for Medicare Beneficiaries

Plus, you must update your microdissection guidelines

Just when Correct Coding Initiative (CCI) policy and CPT® 2012 finally agree on the block as the special-stain code unit of service, CCI takes back its equivalent medical coding policy for immunohistochemistry (IHC) stains.

CMS' new NCCI Policy Manual, effective Jan. 1, 2012, takes account of this and numerous other policies that will impact coding and reimbursement for your lab. Read on to make sure you're up to speed on the following 2012 CPT updates that could affect your bottom line.

2012 CPT Update: Contrast 'Specimen' and 'Block'

CPT® definitions clarify that you must bill one unit of the following listed codes for each separate IHC antibody stain:

88342 – (Immunohistochemistry (including tissue immunoperoxidase), each antibody)

88360 – (Morphometric analysis, tumor immunohistochemistry (e.g., Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, each antibody; manual)

88361 – (… using computer-assisted technology)

Nonetheless the formal descriptors don't tell the complete story -- one unit for "each antibody" isn't all you need to consider. Longstanding AMA advice is that the full unit of service prescription for 88342 and 88360-88361, while executing 2012 CPT lookup, may be defined as 'each uniquely identified (reported) antibody per each dissimilar specimen.

Medicare approved this definition until the Oct. 1, 2009 NCCI Policy Manual update, when it departed from the AMA by concentrating on the surgical pathology block instead of specimen.

In a startling reversal of a policy that has been valid since Oct. 2009, Medicare is going back to the specimen as the unit of service for IHC codes 88342, 88360 and 88361 as an alternative of the block.

Example: The pathologist observes a sentinel lymph node biopsy for a breast cancer patient. He processes the node in two blocks, with three pancytokeratin-stained slides from each of three levels in each block for a total of 18 slides. Before Jan. 1 you would bill the special stain as 88342 x 2 for the two blocks, but after that date, after executing 2012 CPT lookup, you'll require to bill only one unit of 88342 for the single specimen. That's a pay cut of $105.52 (2012 physician fee schedule national amount, conversion factor 34.0376).

Never per slide: Although the previous example involves 18 slides and you could legitimately bill one unit of 88342 for a specimen exam involving a single IHC-stained slide, you must never code special stains per slide.

Notice 'Cocktail' Difference

An additional way you stand to lose IHC stain pay involves Medicare's new policy for multiple-antibody stains.

2012 CPT Lookup : Prior to Jan. 1, an IHC stain consisted of multiple antibodies warranted multiple units of service providing you documented that each antibody provided distinct diagnostic information. It's not the case anymore. The latest NCCI Policy Manual mantains that the physicians must not report more than one unit of service per specimen for an immunohistochemical antibody(s) stain (procedure) even though it contains multiple separately interpretable antibodies.

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