Pathology Coding: Earn Molecular Studies Preparation Pay
Here are six tips that'll show you the do's and don'ts of reporting 88387 and +88388.
When your pathologist carries out sterile macroscopic dissection to prep tissue for molecular diagnostics tests, you did not have a way to capture the service - until now. Avail the benefit of this new payment opportunity by learning when you can and cannot use the 2010 codes, how to document the service, and what you require to know for right billing.
Tip 1:
Be aware of the 'macro' service
CPT 2010 comes with two new codes to describe surgical pathology tissue prep for some ancillary tests:
88387 - Macroscopic examination, dissection, and preparation of tissue for nonmicroscopic analytical studies (example:, nucleic acid-based molecular studies); each tissue preparation (e.g., a single lymph node)
+88388 -... in combination with a touch imprint, intraoperative consultation, or frozen section, each tissue preparation (example: a single lymph node) (List differently additionally to code for primary procedure).
"These codes explain macroscopic examination and processing of the target tissue like a sentinel lymph node for non-microscopic molecular analysis," according to Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc. and publisher of the Pathology Service Coding Handbook, in The Villages, Fla.
The processing covers work like "dissecting an appropriate part of the tissue away from the main specimen, and cutting and labeling thin sections under sterile conditions," explains Padget.
Tip 2:
Use Codes to Pre-analytic Work
You should not go for 88387 or +88388 when the pathologist retrospectively chooses a tissue block for molecular analysis based on initial slide review.
You have to think "pre-analytic" and "macroscopic" while deciding whether to go for one of these codes," says Padget. "Early indications are that some labs are not using them the right way - if you are choosing tumor cells from paraffin embedded material or cutting sections from a block for send-out, that is not covered by 88387 or +88388."
Tip 3:
Do away with 88387-88388 for Microbiology or Flow Cytometry Prep
According to CPT 2010 [http://codinginstitute.com/1], you should not go for 88387-88388 for tissue preparation for microbiologic cultures or flow cytometric studies."
"This means you cannot report 88387 or +88388 as prep for any microbiology codes or 88182-88189 (Flow cytometry...)", according to Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha.
The work covered in prepping tissue for microbiology cultures or flow cytometry studies are part of those respective codes.
Tip 4:
Stay away from 88387-88388 for Microscopy Prep
As the code descriptors specifically reference "non-microscopic analytical studies" you shouldn't go for 88387 or +88388 for tissue prep for special stains or immunohistochemistry - based tumor morphometry analysis, according to Padget.
Do not report 88387-88388 when the pathologist preps tissue exclusively for any of the following microscopy-based ancillary studies:
Special stains (88312-88319)
Immunohistochemistry (IHC) (88342, 88360-88361)
Immunofluorescent study (88346-88347)
Electron microscopy (88348-88349).
Tip 5:
Report Codes With Ancillary Molecular Diagnostics
You should go for 88387 or +88388 for special tissue prep for nucleic-acid based molecular studies," as per the code definition. That would cover any codes from the range 83890-83913 (Molecular diagnostics...).
According to Slagle, "The definition makes it possible for you to use 88387-88388 when the pathologist carries out a macroscopic exam and dissection to arrange tissue for molecular diagnostics tests like polymerase chain reaction (PCR)."
For example: The pathologist might process a sentinel lymph note biopsy and offer distinct sterile macroscopic examination and sectioning for T or B clonality evaluation, points out Sophia Hauxwell,MT-ASCP, laboratory scientist in the University of Nebraska Medical Center Molecular Diagnostics Laboratory in Omaha.
Padget warns, "You need to be discriminating here." Do not report 88387-88388 to separately charge for the conventional gross exam/dissection that takes place with all tissue specimens before microscopic examination. What's more, do not automatically bill the codes every time you order a molecular study. He explains, "The pathology report must document a distinct macroscopic to recognize tumor-containing areas, with dissection of thin sections, all under sterile conditions. He explains, "This level of work is above and ahead of the normal work that takes place at the crossing bench."
And what about FISH? "Our knowledge of 88387-88388 would allow using the codes when the pathologist preps tissue for fluorescence in situ hybridization (FISH)," says Slagle. "FISH meets the criteria of non-microbiology, non-flow cytometry testing concerning nucleic acids."
A note of caution: "I concur that FISH should qualify as it is clearly a DNA or RNA test," says Padget. However with an automated imager, you will make use of a microscope to see the probe staining, which might mean FISH does not pass the "non-microscopic" test, he warns. "So long as you meet other criteria for using 88387 or +88388, you would go for one of those codes with a manual FISH test until I am told otherwise by an authority such as AMA or CMS," concludes Padget.
Stay away from cytogenetics: "I do not think traditional cytogenetics meets the requirements for use with 88387-88388," Padget says. Even though cytogenetics testing as an ancillary service to surgical pathology covers DNA or RNA, it also involves microscopic examination of tissue cultures.
Tip 6:
Identify Unit of Service
The unit of service for codes 88387 and +88388 is "each tissue preparation," which means you can list two units of 88387 or +88388 if the pathologist separately preps two distinct sentinel lymph nodes for molecular testing.
No TC billing: "Even though codes 88387 and +88388 have distinct technical components (TC) under the Medicare physician fee schedule, no authoritative source has shown that you can bill a separate TC when the pathologist does not carry out the professional component," says Padget.
When your pathologist carries out sterile macroscopic dissection to prep tissue for molecular diagnostics tests, you did not have a way to capture the service - until now. Avail the benefit of this new payment opportunity by learning when you can and cannot use the 2010 codes, how to document the service, and what you require to know for right billing.
Tip 1:
Be aware of the 'macro' service
CPT 2010 comes with two new codes to describe surgical pathology tissue prep for some ancillary tests:
"These codes explain macroscopic examination and processing of the target tissue like a sentinel lymph node for non-microscopic molecular analysis," according to Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc. and publisher of the Pathology Service Coding Handbook, in The Villages, Fla.
The processing covers work like "dissecting an appropriate part of the tissue away from the main specimen, and cutting and labeling thin sections under sterile conditions," explains Padget.
Tip 2:
Use Codes to Pre-analytic Work
You should not go for 88387 or +88388 when the pathologist retrospectively chooses a tissue block for molecular analysis based on initial slide review.
You have to think "pre-analytic" and "macroscopic" while deciding whether to go for one of these codes," says Padget. "Early indications are that some labs are not using them the right way - if you are choosing tumor cells from paraffin embedded material or cutting sections from a block for send-out, that is not covered by 88387 or +88388."
Tip 3:
Do away with 88387-88388 for Microbiology or Flow Cytometry Prep
According to CPT 2010 [http://codinginstitute.com/1], you should not go for 88387-88388 for tissue preparation for microbiologic cultures or flow cytometric studies."
"This means you cannot report 88387 or +88388 as prep for any microbiology codes or 88182-88189 (Flow cytometry...)", according to Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha.
The work covered in prepping tissue for microbiology cultures or flow cytometry studies are part of those respective codes.
Tip 4:
Stay away from 88387-88388 for Microscopy Prep
As the code descriptors specifically reference "non-microscopic analytical studies" you shouldn't go for 88387 or +88388 for tissue prep for special stains or immunohistochemistry - based tumor morphometry analysis, according to Padget.
Do not report 88387-88388 when the pathologist preps tissue exclusively for any of the following microscopy-based ancillary studies:
Tip 5:
Report Codes With Ancillary Molecular Diagnostics
You should go for 88387 or +88388 for special tissue prep for nucleic-acid based molecular studies," as per the code definition. That would cover any codes from the range 83890-83913 (Molecular diagnostics...).
According to Slagle, "The definition makes it possible for you to use 88387-88388 when the pathologist carries out a macroscopic exam and dissection to arrange tissue for molecular diagnostics tests like polymerase chain reaction (PCR)."
For example: The pathologist might process a sentinel lymph note biopsy and offer distinct sterile macroscopic examination and sectioning for T or B clonality evaluation, points out Sophia Hauxwell,MT-ASCP, laboratory scientist in the University of Nebraska Medical Center Molecular Diagnostics Laboratory in Omaha.
Padget warns, "You need to be discriminating here." Do not report 88387-88388 to separately charge for the conventional gross exam/dissection that takes place with all tissue specimens before microscopic examination. What's more, do not automatically bill the codes every time you order a molecular study. He explains, "The pathology report must document a distinct macroscopic to recognize tumor-containing areas, with dissection of thin sections, all under sterile conditions. He explains, "This level of work is above and ahead of the normal work that takes place at the crossing bench."
And what about FISH? "Our knowledge of 88387-88388 would allow using the codes when the pathologist preps tissue for fluorescence in situ hybridization (FISH)," says Slagle. "FISH meets the criteria of non-microbiology, non-flow cytometry testing concerning nucleic acids."
A note of caution: "I concur that FISH should qualify as it is clearly a DNA or RNA test," says Padget. However with an automated imager, you will make use of a microscope to see the probe staining, which might mean FISH does not pass the "non-microscopic" test, he warns. "So long as you meet other criteria for using 88387 or +88388, you would go for one of those codes with a manual FISH test until I am told otherwise by an authority such as AMA or CMS," concludes Padget.
Stay away from cytogenetics: "I do not think traditional cytogenetics meets the requirements for use with 88387-88388," Padget says. Even though cytogenetics testing as an ancillary service to surgical pathology covers DNA or RNA, it also involves microscopic examination of tissue cultures.
Tip 6:
Identify Unit of Service
The unit of service for codes 88387 and +88388 is "each tissue preparation," which means you can list two units of 88387 or +88388 if the pathologist separately preps two distinct sentinel lymph nodes for molecular testing.
No TC billing: "Even though codes 88387 and +88388 have distinct technical components (TC) under the Medicare physician fee schedule, no authoritative source has shown that you can bill a separate TC when the pathologist does not carry out the professional component," says Padget.
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