Billing IHC Cocktails

[LADoc00]

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I know Prostate and Breast Triple stains used to be 3x 88342 TC and PC charges. Then Medicare changed the rules and supposedly allowed only 1 TC charge.

But what about PC charges? I thought I following guidelines about this but have some industry types telling me it all changed 6 or so months ago.

I know at one point people claimed you had to list each individual antibody and the result to get the 88342-26x3. Others said no you didnt need to. etc.

What is the final word on this?

 

[Kunu]

88342x2
one professional charge, one technical charge per immuno per specimen

 

[yaah]

Since doing a cocktail is currently a money loser, and cocktails are becoming increasingly important, I suspect something is going to change. Probably a new code will pop up for "multiple immunostains on one slide."

I remember going to USCAP last year and seeing all the booths for the companies trying to sell various cocktails for diagnosis and prognosis, just after I heard about the new billing trend. I really can't believe that it will continue to be a money loser. There are too many things at stake, especially with increasing need to conserve tissue on smaller and smaller biopsies. It just doesn't make sense.

 

[NuckingFuts]

88342x2
one professional charge, one technical charge per immuno per specimen

This.

 

[pathstudent]

88342x2
one professional charge, one technical charge per immuno per specimen

Well that would be two globals.

I would say one 88342 or if you are breaking it up (i.e. you only performed one or the other) 88342-TC or 88342-26.

88342 = 88342-TC + 88342-26

 

[SLUsagar]

I know Prostate and Breast Triple stains used to be 3x 88342 TC and PC charges. Then Medicare changed the rules and supposedly allowed only 1 TC charge.

But what about PC charges? I thought I following guidelines about this but have some industry types telling me it all changed 6 or so months ago.

I know at one point people claimed you had to list each individual antibody and the result to get the 88342-26x3. Others said no you didnt need to. etc.

What is the final word on this?

Confirmed from our national biller, regardless of the # of combo IHCs performed on 1 slide, only 1 TC and PC should be billed.

As an aside, I've now seen outside/re-review prostate bx's from OUR labs in which they did the prostate combos separately (i.e. on 3 separate slides). Guess that is their way around it, although in my opinion a poor diagnostic approach.

 

[WEBB PINKERTON]

Confirmed from our national biller, regardless of the # of combo IHCs performed on 1 slide, only 1 TC and PC should be billed.

As an aside, I've now seen outside/re-review prostate bx's from OUR labs in which they did the prostate combos separately (i.e. on 3 separate slides). Guess that is their way around it, although in my opinion a poor diagnostic approach.

Is OUR lab the one that Oppenheimer works for?

Sounds like he had some issues with the internet from this lawsuit.

http://www.uri-geller.com/libel_net.htm