[Histonet] IHC billing

[Lee Loss]

Hi all,

I know this topic has been tossed around a bit already.  We are having some interpretation issues with one insurance provider on billing for IHC using the CPT codes 88342 & 88343.  Our interpretation is to use the 88342 for the first uniquely identifiable antibody per slide and 88343 for each additional antibody per slide.  This particular large insurance company is telling us (and reimbursing us accordingly) that they will reimburse for the first antibody per case and 88343 for any thereafter, in spite of the language of the new AMA guidelines that they quote within their own policies.  How are other labs interpreting this new rule and has anyone else had issues with insurance companies using different interpretations?

They also want us to explain to them why it is necessary to use separate slides for additional antibodies as opposed to applying all of the antibodies to one slide.  I believe I have answered that question for them but would love to hear thoughts on that as well.  I'm sure there are some really good points that I haven't thought of.  Thanks in advance!

Lee
Dermatology Associates


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