| Here are six tips that'll show you the do's and don'ts | | | | 88360-88361) Immunofluorescent study |
| of reporting 88387 and +88388. | | | | (88346-88347) Electron microscopy (88348-88349). |
| When your pathologist carries out sterile macroscopic | | | | Tip 5:Report Codes With Ancillary Molecular |
| dissection to prep tissue for molecular diagnostics | | | | DiagnosticsYou should go for 88387 or +88388 for |
| tests, you did not have a way to capture the service | | | | special tissue prep for nucleic-acid based molecular |
| - until now. Avail the benefit of this new payment | | | | studies," as per the code definition. That would cover |
| opportunity by learning when you can and cannot use | | | | any codes from the range 83890-83913 (Molecular |
| the 2010 codes, how to document the service, and | | | | diagnostics …).According to Slagle, "The definition |
| what you require to know for right billing. | | | | makes it possible for you to use 88387-88388 when |
| Tip 1: | | | | the pathologist carries out a macroscopic exam and |
| Be aware of the ‘macro' service | | | | dissection to arrange tissue for molecular diagnostics |
| CPT 2010 comes with two new codes to describe | | | | tests like polymerase chain reaction (PCR)." For |
| surgical pathology tissue prep for some ancillary tests: | | | | example: The pathologist might process a sentinel |
| 88387 — Macroscopic examination, dissection, and | | | | lymph note biopsy and offer distinct sterile |
| preparation of tissue for nonmicroscopic analytical | | | | macroscopic examination and sectioning for T or B |
| studies (example:, nucleic acid-based molecular | | | | clonality evaluation, points out Sophia |
| studies); each tissue preparation (e.g., a single lymph | | | | Hauxwell,MT-ASCP, laboratory scientist in the |
| node) +88388 — … in combination with a touch | | | | University of Nebraska Medical Center Molecular |
| imprint, intraoperative consultation, or frozen section, | | | | Diagnostics Laboratory in Omaha. Padget warns, "You |
| each tissue preparation (example: a single lymph | | | | need to be discriminating here." Do not report |
| node) (List differently additionally to code for primary | | | | 88387-88388 to separately charge for the |
| procedure). "These codes explain macroscopic | | | | conventional gross exam/dissection that takes place |
| examination and processing of the target tissue like a | | | | with all tissue specimens before microscopic |
| sentinel lymph node for non-microscopic molecular | | | | examination. What's more, do not automatically bill |
| analysis," according to Dennis Padget, MBA, CPA, | | | | the codes every time you order a molecular study. |
| FHFMA, president of DLPadget Enterprises Inc. and | | | | He explains, "The pathology report must document a |
| publisher of the Pathology Service Coding Handbook, | | | | distinct macroscopic to recognize tumor-containing |
| in The Villages, Fla. The processing covers work like | | | | areas, with dissection of thin sections, all under sterile |
| "dissecting an appropriate part of the tissue away | | | | conditions. He explains, "This level of work is above |
| from the main specimen, and cutting and labeling thin | | | | and ahead of the normal work that takes place at |
| sections under sterile conditions," explains Padget. Tip | | | | the crossing bench." And what about FISH? "Our |
| 2:Use Codes to Pre-analytic Work You should not go | | | | knowledge of 88387-88388 would allow using the |
| for 88387 or +88388 when the pathologist | | | | codes when the pathologist preps tissue for |
| retrospectively chooses a tissue block for molecular | | | | fluorescence in situ hybridization (FISH)," says Slagle. |
| analysis based on initial slide review. You have to | | | | "FISH meets the criteria of non-microbiology, |
| think "pre-analytic" and "macroscopic" while deciding | | | | non-flow cytometry testing concerning nucleic acids." |
| whether to go for one of these codes," says Padget. | | | | A note of caution: "I concur that FISH should qualify |
| "Early indications are that some labs are not using | | | | as it is clearly a DNA or RNA test," says Padget. |
| them the right way – if you are choosing tumor | | | | However with an automated imager, you will make |
| cells from paraffin embedded material or cutting | | | | use of a microscope to see the probe staining, which |
| sections from a block for send-out, that is not | | | | might mean FISH does not pass the |
| covered by 88387 or +88388." Tip 3:Do away with | | | | "non-microscopic" test, he warns. "So long as you |
| 88387-88388 for Microbiology or Flow Cytometry | | | | meet other criteria for using 88387 or +88388, you |
| PrepAccording to CPT 2010, you should not go for | | | | would go for one of those codes with a manual FISH |
| 88387-88388 for tissue preparation for microbiologic | | | | test until I am told otherwise by an authority such as |
| cultures or flow cytometric studies." "This means you | | | | AMA or CMS," concludes Padget. Stay away from |
| cannot report 88387 or +88388 as prep for any | | | | cytogenetics: "I do not think traditional cytogenetics |
| microbiology codes or 88182-88189 (Flow cytometry | | | | meets the requirements for use with 88387-88388," |
| …)", according to Peggy Slagle, CPC, billing | | | | Padget says. Even though cytogenetics testing as an |
| compliance coordinator at the University of Nebraska | | | | ancillary service to surgical pathology covers DNA or |
| Medical Center in Omaha. The work covered in | | | | RNA, it also involves microscopic examination of |
| prepping tissue for microbiology cultures or flow | | | | tissue cultures. Tip 6:Identify Unit of Service The unit |
| cytometry studies are part of those respective | | | | of service for codes 88387 and +88388 is "each |
| codes. Tip 4:Stay away from 88387-88388 for | | | | tissue preparation," which means you can list two |
| Microscopy PrepAs the code descriptors specifically | | | | units of 88387 or +88388 if the pathologist |
| reference "non-microscopic analytical studies" you | | | | separately preps two distinct sentinel lymph nodes |
| shouldn't go for 88387 or +88388 for tissue prep for | | | | for molecular testing. No TC billing: "Even though |
| special stains or immunohistochemistry – based | | | | codes 88387 and +88388 have distinct technical |
| tumor morphometry analysis, according to Padget. Do | | | | components (TC) under the Medicare physician fee |
| not report 88387-88388 when the pathologist preps | | | | schedule, no authoritative source has shown that you |
| tissue exclusively for any of the following | | | | can bill a separate TC when the pathologist does not |
| microscopy-based ancillary studies: Special stains | | | | carry out the professional component," says Padget. |
| (88312-88319) Immunohistochemistry (IHC) (88342, | | | | |