[Histonet] 2014 CMS/AMA IHC Changes

[Roxanne]

We are incorporating the new rules into our LIS/billing system for 2014.  I just to verify how others are interpreting these rules.

Medicare - my understanding is that the G codes are used for all IHC, G0461 for the first IHC and G0462 for any additional antibody on the same specimen, regardless if it is a cocktail or not.  I think this language is clear G0461 = "per specimen;first single or multiplex antibody" and G0462 = "per specimen; each additional single or multiples antibody"

Third Party Payors - AMA changed the wording from specimen to block, to enable billing separate blocks on the same specimen.  88342 = "each separately identifiable antibody per block; first separately identifiable antibody per slide".  88343 = "each additional, separately identifiable antibody per slide".

So it is clear that 88343 is for cocktail stains, but the guidelines changed from specimen to block.  And the G-codes clearly state specimen, not block and it doesnt matter if it is a cocktail or not.

My question is, do you agree with my understanding?   Do you think that AMA means to say that a block equates to a specimen?

Thanks,
Roxanne