Brodell PATHMOHSIHC Coding - 2016 SAM HANDOUT€œIf the Mohs surgeon additionally stains one or more blocks from that specimen with an additional different single antibody immunohistochemistry
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CPT 2016 Definition: Specimen (1) “A specimen is defined as tissue or tissues that is (are) submitted for individual and separate attention, requiring individual examination and pathologic diagnosis.” The above definition precedes the 88300 – 88309 histopathology code series. However, the definition is applied to all other pathology codes that include the word specimen in their descriptors.
CPT 2016 Definition: Specimen (2) “Two or more such specimens from the same patient (eg, separately identified endoscopic biopsies, skin lesions) are each appropriately assigned an individual code reflective of its proper level of service.” Mohs surgery: what constitutes a separately identified skin lesion?
CPT codes do not distinguish between a tiny punch or shave biopsy and deep/wide skin excision that is based on “averaging” principle (both are 88305). Despite large time/work consuming cases with multiple blocks, the fairness principle should not be applied to CPT coding.
Can these codes ever be used in Dermatopathology????
CPT 2016 Definitions: 88307 Surgical pathology, gross and microscopic examination
requiring microscopic evaluation of surgical margins (deep excision/re-excision without tumor)
88309 Surgical pathology, gross and microscopic examination
requiring microscopic evaluation of surgical margins (deep excision/re-excision with tumor)
NOTE: 88307 and 88309 have been extrapolated from “soft tissue” CPT coding by some dermatopathologists for excisions that include subcutaneous fat. However, according to the UMHS’s Specimen to Charge Code Rapid Finder List this should only be used when “the excision is so deep that any other layer of skin is incidental to the dominant subcutaneous tissue and /or muscle that comprises the true specimen.”
In general, most coding consultants recommend no higher CPT code level than 88305 for any specimen that translates to a “skin” ICD-9-CM diagnosis code. NOTE: CMS does permit upcoding as long as the documentation can be substantiated by the provider….
CPT 2016 Definitions: IHC (1) 88342 Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure 88341 each additional single antibody stain procedure
(List separately in addition to code for primary procedure)
CPT 2016 Definitions: IHC (2) 88344 each multiplex antibody stain procedure (Do not use more than one unit of 88341, 88342, or 88344 for the same separately identifiable antibody per specimen)
CPT 2016 Definitions: IHC (3) (When multiple separately identifiable antibodies are applied to the same specimen [ie, multiplex antibody stain procedure], use one unit of 88344) (When multiple antibodies are applied to the same slide that are not separately identifiable, [eg, antibody cocktails], use 88342, unless an additional separately identifiable antibody is also used, then use 88344)
NCCI Policy Manual for 2016, chapter 3 (effective 1/1 2016) -- Part 1
“If a Mohs surgeon removes a tumor specimen and divides it into multiple pieces of tissue, creates a block from each piece of tissue, and stains one or more blocks from that specimen with an initial single antibody immunohistochemistry stain, the Mohs surgeon should report only one (1) unit of service (UOS) of CPT code 88342 (Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure). Only one (1) UOS of CPT code 88342 may be reported per specimen.”
NCCI Policy Manual for 2016, chapter 3 (effective 1/1 2016) -- Part 2
“If the Mohs surgeon additionally stains one or more blocks from that specimen with an additional different single antibody immunohistochemistry (immunocytochemistry) stain, CPT code 88341 (immunohistochemistry or immunocytochemistry, per specimen/ each additional single antibody stain procedure (List separately in addition to code for primary procedure) may be reported with one (1) UOS per different antibody stain procedure. The UOS for these codes is not each block derived from a single specimen.”
NCCI Policy Manual for 2016, chapter 3 (effective 1/1/2016)
“If the Mohs surgeon additionally stains one or more blocks from that specimen with an additional different single antibody immunohistochemistry (immunocytochemistry) stain, CPT code 88341 (immunohistochemistry or immunocytochemistry, per specimen/ each additional single antibody stain procedure (List separately in addition to code for primary procedure) may be reported with one (1) UOS per different antibody stain procedure.”
First stage of Mohs, lentigo maligna, cheek o One tissue layer excised o Quadrisected o Each piece placed upon a separate block, and separate slides made
Slides from each block are stained with: § H & E § Melan-A
First stage of Mohs, lentigo maligna, cheek o One tissue layer excised o Quadrisected o Each piece placed upon a separate block, and separate slides made
Slides from each block are stained with: § H & E § Melan-A
Your answer: 17311 – Mohs surgery, first stage 88342 – Immunohistochemistry,
First stage of Mohs, lentigo maligna, cheek o One tissue layer excised o Quadrisected o Each piece placed upon a separate block, and separate slides made
Slides from each block are stained with: § H & E § Melan-A
Your answer: 17311 – Mohs surgery, first stage 88342 – Immunohistochemistry,
First stage of Mohs, lentigo maligna, cheek o One tissue layer excised o Quadrisected o Each piece placed upon a separate block, and separate slides made
Slides from each block are separately stained with: § H & E § Melan-A § MITF
First stage of Mohs, lentigo maligna, cheek o One tissue layer excised o Quadrisected o Each piece placed upon a separate block, and separate slides made
Slides from each block are stained with: § H & E § Melan-A § MITF Answer: 17311 – Mohs surgery, first stage 88342.59 – IHC, one specimen, one stain 88341 – IHC, one specimen, second stain
First stage of Mohs, spindle cell SCC, temple o One contiguous tissue layer excised o Bisected o Each half placed upon a separate block, separate slides made
1 2 Slides from each block stained with: § H&E § Pancytokeratin AE1/AE3
Spindle cell SCC Slides from each block stained with: § H&E § Pancytokeratin AE1/AE3
Answer: 17311 – Mohs surgery, first stage 88342.59 – antibody cocktail stain: single stain, individual antibodies not distinguishable .59 modifier appended as per NCCI col 1/col 2
Two stages of Mohs, lentigo maligna, cheek o First stage: one tissue layer, quadrisected, each piece placed upon a block o Second stage: two separate tissues excised, identified, and processed
individually as two separate blocks
Slides from each block are stained with: § H & E § Melan-A
LCD: Special Histochemical Stains and Immunohistochemical Stains
• Pertains to all instances of immunohistochemical staining: does not differentiate between formalin fixed, paraffin embedded tissue and Mohs surgical specimens
• MACs with above Local Coverage Determination (LCD): – Noridian – First Coast – CGS