[Histonet] [IHCRG] Re: another point on billing codes

Wed Aug 29 13:16:33 CDT 2007

If you use an FDA approved kit for the staining which not only costs much more than a routine 88342, but also requires more steps that may not fit into an IHC lab's routine protocol (since you cannot alter any step in the kit) calling for special handling and more labor, I can see justification in increased RVU for the technical component.  I currently use FDA approved kits for HercepTest & EGFR staining and I can say, without question, that the technical cost, in terms of both labor and reagents, is more than when I did these two IHC's before bringing in the kits. 

My Opinion,

Glen Dawson
IHC Manager
Milwaukee, WI

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu]On Behalf Of Richard
Cartun
Sent: Wednesday, August 29, 2007 12:23 PM
To: rorr <@t> enh.org; pruegg <@t> ihctech.net; histonet <@t> lists.utsouthwestern.edu;
Joyce Weems
Cc: IHCRG Resource Group (E-mail)
Subject: RE: [Histonet] [IHCRG] Re: another point on billing codes

Yes, you're correct.  However, in my opinion, the increased RVU for the technical component of 88361 in not justified.

Richard

Richard W. Cartun, Ph.D.
Director, Immunopathology & Histology
Assistant Director, Anatomic Pathology
Hartford Hospital
80 Seymour Street
Hartford, CT  06102
(860) 545-1596
(860) 545-0174 Fax

>>> "Weems, Joyce" <JWEEMS <@t> sjha.org> 08/29/07 11:59 AM >>>
Except for quantitative analysis, the instructions in the AMA CPT codebook are NOT to report 88342 with 88360 and 88361 unless each procedure is for a different antibody. 88360 - manual, 88361 - computer assisted technology.

Joyce Weems
Pathology Manager
Saint Joseph's Hospital 
5665 Peachtree Dunwoody Rd NE
Atlanta, GA 30342
404-851-7376 - Phone
404-851-7831 - Fax

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu 
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu]On Behalf Of Richard
Cartun
Sent: Wednesday, August 29, 2007 11:35 AM
To: rorr <@t> enh.org; pruegg <@t> ihctech.net; histonet <@t> lists.utsouthwestern.edu 
Cc: 'IHCRG Resource Group (E-mail)'
Subject: [Histonet] [IHCRG] Re: another point on billing codes

I also believe that 88360 or 88361 should be used for professional interpretation (and billing) only; the technical should always be 88342 since you are not doing anything different to the slide whether you look at it under the microscope or you use image analysis.  Only my opinion .......

Richard

Richard W. Cartun, Ph.D.
Director, Immunopathology & Histology
Assistant Director, Anatomic Pathology
Hartford Hospital
80 Seymour Street
Hartford, CT  06102
(860) 545-1596
(860) 545-0174 Fax

>>> "Patsy Ruegg" <pruegg <@t> ihctech.net> 08/29/07 11:05 AM >>>

All,
I find this thread interesting and was wondering if I have everyone's
permission to use this as one of the questions for the NSH IHC Forum?
Patsy

-----Original Message-----
From: ihcrg <@t> googlegroups.com [mailto:ihcrg <@t> googlegroups.com] On Behalf Of
Richard Cartun
Sent: Wednesday, August 29, 2007 6:49 AM
To: rorr <@t> enh.org; histonet <@t> lists.utsouthwestern.edu 
Cc: IHCRG Resource Group (E-mail)
Subject: [IHCRG] Re: another point on billing codes

Interesting point.  We use semiquantitative scoring for ER, PR, and HER2
performed on primary breast CAs.  Therefore, we use 88360x3 for these
markers whether they are positive or negative.

Richard

Richard W. Cartun, Ph.D.
Director, Immunopathology & Histology
Assistant Director, Anatomic Pathology
Hartford Hospital
80 Seymour Street
Hartford, CT  06102
(860) 545-1596
(860) 545-0174 Fax

>>> "Orr, Rebecca" <ROrr <@t> enh.org> 08/29/07 7:24 AM >>>

Helayne,
I'm interested in everyone's input on this thread.
Charging for Breast cases seems to be as unclear as the processing
guidelines.
We are now in the process of figuring out charges if the ER PR Her2
results are negative.

ER PR Her2 are quantitative (2+, 3+) or semi quantitative (weakly or
strongly positive, etc)
Assuming these markers are ordered on a breast cancer (not a benign
breast), even a negative result is quantitative and contributes to the
outcome of the therapy., isn't this right?  
Please steer me in the right direction if this is an incorrect point.

So we are being told by our billing folks that we must change the code
on the negative resulted ER PR her2 to a lesser charge.
I can understand if CPT may think doctors are charging on unnecessary
IHC tests, but they are focusing on the wrong tests.
(in my opinion).
A negative or 0  result on these particular markers should NOT be
synonymous with "

Quite perplexing and frustrating. 

---Original Message-----
> From: histonet-bounces <@t> lists.utsouthwestern.edu 
> [mailto:histonet-bounces <@t> lists.utsouthwestern.edu]On Behalf Of Parker,
> Helayne
> Sent: Tuesday, August 28, 2007 4:25 PM
> To: histonet <@t> lists.utsouthwestern.edu 
> Subject: [Histonet] CPT codes
>
>
> Hi all,
>  Does anyone know the correct charges to charge a breast lump that
must
> be inked.  Someone told us we could only charge a -307 if it has
cancer
> in the micro margins.  As much gross work is done either way (cancer
or
> not) so what is the real truth ?  We have given most lumps 305 and I
am
> thinking we are undercharging.
>
> Thanks,
> Helayne Parker, HT (ASCP)
> Histology Section Head
> Skaggs Community Health Center
> Branson, Missouri
Becky Orr CLA,HT(ASCP)QIHC
Anatomic Pathology
Evanston Northwestern Healthcare
847-570-2771

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