[Histonet] Hot Topic Medicare Code

Thu Jan 2 17:17:48 CST 2014

AMA prescribes codes 88342 and 88343 for qualitative IHC (Non-Medicare):
The AMA's CPT-2014 codebook offers two codes for reporting with qualitative immunohistochemistry (IHC) testing. The codes and official parenthetical instructions for their use starting Jan. 1 are as follows:
88342  Immunohistochemistry or immunocytochemistry, each separately identifiable antibody per block, cytologic preparation, or hematologic smear; first separately identifiable antibody per slide
            (Do not report 88342 in conjunction with 88360 or 88361 for the same antibody)
            (For quantitative or semi-quantitative immunohistochemistry, see 88360, 88361)
88343 each additional separately identifiable antibody per slide (List separately in addition to code for primary procedure)
      (Use 88343 in conjunction with 88342)
      (When multiple antibodies are applied to the same slide, use one unit of 88342 for the first separately identifiable antibody and one unit of 88343 for each additional identifiable antibody)

CMS prescribes codes G0461 and G0462 for qualitative IHC:
CMS will not accept CPT code 88342 or 88343 on a claim effective with dates of service on and after Jan. 1, 2014: Those two codes are "not valid for Medicare purposes" and will be summarily denied if billed. To report a professional, technical or global charge for qualitative immunohistochemistry (IHC) testing for a Medicare beneficiary on and after Jan. 1, 2014, you must use the applicable HCPCS Level II code as follows:
G0461 Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain
G0462       each additional single or multiplex antibody stain (List separately in addition to code for primary procedure)
Codes G0461 and G0462 have 26 and TC modifier lines in the 2014 physician fee schedule, so you'll bill them using the modifier (or no modifier, if entitled to bill the global service) that applies to your practice and any given Medicare beneficiary claim.
CMS prescribes that you continue to bill for qualitative IHC testing 'per specimen' as you have since Jan. 1, 2012. Furthermore, you'll continue to bill for quantitative IHC testing 'per specimen' using CPT codes 88360 and 88361 just as you do today and have done since Jan. 1, 2012.

Effective January 1, 2014, per CMS (Medicare) all prostate needle biopsies, any method will be reported with the appropriate HCPCS code. They are:

G0416-Surgical pathology, gross and microscopic examination for prostate needle biopsies, any method: 10 to 20 specimens  (This is the code that pertains to most of our Prostate Needle Biopsy Cases)

G0417- Surgical pathology, gross and microscopic examination for prostate needle biopsies, any method: 21 to 40 specimens

G0418- Surgical pathology, gross and microscopic examination for prostate needle biopsies, any method: 41 to 60 specimens

G0419- Surgical pathology, gross and microscopic examination for prostate needle biopsies, any method: greater than 60 specimens

Per CMS, the descriptor was changed to say "any method" and is no longer tied to the surgical approach. So now it will be the count of individual biopsies that will tell you how to code your case. If you have 12 vials, you will report G0416. Please note that for nine or less you will continue to report 88305 per the number of separately identified biopsies. This will apply for CMS patients nationwide.

Walter Benton HT(ASCP)QIHC
Histology Supervisor
Chesapeake Urology Associates
806 Landmark Drive, Suite 127
Glen Burnie, MD 21061
443-471-5850 (Direct)
410-768-5961 (Lab)
410-768-5965 (Fax)
ChesapeakeUrology.com

Voted a Best Place to Work by
Baltimore and Modern Healthcare
Magazines.
________________________________________
From: histonet-bounces <@t> lists.utsouthwestern.edu [histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Mary Ann Deathridge [madeathridge <@t> pastnashville.com]
Sent: Thursday, January 02, 2014 5:34 PM
To: histonet <@t> lists.utsouthwestern.edu
Subject: [Histonet] Hot Topic Medicare Code

HAPPY NEW YEAR HISTONETTERS!

Ok, so here is a question for 2014 coders.    How do you code ( or should I
say get to code) a doublestain for Medicare and for non-medicare?

G0461 and G0462 (Medicare) and 88342 and 88343 for non-medicare. Can you
charge for both antibodies in the doublestain or do you only charge one
code and eat the second antibody on the same slide.

Thanks for replies in advance.

Maryann Deathridge, BS, HT (ASCP)

Lab Manager

Pathology Assoc.. of St. Thomas

615-298-4100, Fax: 615-298-4141

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