[Histonet] NCCI policy on IHC billing

Sheila Fonner sfonner <@t> labpath.com
Thu Jan 5 06:35:03 CST 2012


This is a little different from what I understood yesterday.  I thought that
it was stated you could only bill once per part, such as an S-100 on part
A,B,C would be fine, but not on A1,A3, and A5.

I did not read anything about only being allowed to order one antibody. I
thought panels were understood and completely acceptable as long as you were
only billing for each individual stain once per part.  Also, I understood
the part about cocktail stains now being billed as one charge instead of

Do you have a direct link to what you are stating?  I mentioned it to our
powers that be yesterday and they did not seem too concerned since they had
heard absolutely nothing about it from our billing company.

I would like to have some concrete proof before I go back to them with more
bad news.

Sheila, HT (ASCP)
KDL Pathology
Knoxville, TN

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Sally Price
Sent: Thursday, January 05, 2012 12:17 AM
To: histonet <@t> lists.utsouthwestern.edu
Subject: RE: [Histonet] NCCI policy on IHC billing

I waited a few days to see how others might weigh in after this information
was posted.  Call me crazy, but I expected quite a bit more reaction from
our community.  How is it that such a signifcant change in how IHC testing
may be conducted and will be paid for in the future can produce so little

The way this new policy is stated, it looks pretty straightfoward: one
antibody (IHC procedure) per specimen; so, when it's necessary to use a
battery of IHC stains to determine the origin of an undifferentiated
neoplasm, the lab can only bill for one procedure.  How could such an
approach be possible?  And what about multi-antibody procedures, which are
usually more cost effective than single-antibody procedures?

Come on folks, this is a big deal becuase IHC staining is essential to to
the practice of anatomic pathology and provides a lot of us with our
livelihood.  I know I'm not alone in thinking that the CMS needs to know
that this new policy is completely impractical and must be changed.  Sure,
there's some unnecessary IHC procedures being performed, but this isn't the
way limit the problem.

Message: 6
Date: Fri, 30 Dec 2011 12:33:17 -0600
From: "Webb, Dorothy L" <Dorothy.L.Webb <@t> HealthPartners.Com>
Subject: [Histonet] NCCI policy update
To: "'histonet <@t> lists.utsouthwestern.edu'"

Is everyone aware that beginning 1/1/12, we can no longer bill for each
block regarding IHC billing, only one unit of billing for each part type no
matter how many blocks are stained? Also IHC "cocktail" stains, such as
PIN4 must now be billed as one unit even though multiple antibodies are
reported out.

Kind of a surprising reversal of the policy set in motion 10/1/2009.
SPECIMEN becomes the unit of service rather than block(s) for IHC codes
88342, 88360, and 88361.

Happy New Year to everyone out there. May 2012 find you happiness and

Dorothy Webb, HT
Regions Histology TS
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