Special Stains Update for 2012
The 2012 edition of the AMA CPT Code book put an end to the controversy regarding the unit of service for special stains for codes 88312-88319. Each code in the 88312-88319 code series is now accompanied by the corresponding parenthetical statement:
Report one unit of 8831X for each special stain, on each surgical pathology block, cytologic specimen, or hematologic smear.
This additional instruction supports the instruction first issued in the October 2009 National Correct Coding Initiative (NCCI) edit narratives. CMS edit narratives were updated January 1, 2012 and now state:
The unit of service for special stains (CPT codes 88312-88313) is each stain. If it is medically reasonable and necessary to perform the same stain on more than one specimen or more than one block of tissue from the same specimen, additional units of service may be reported for the additional specimen(s) or block(s). Physicians should not report more than one unit of service for a stain performed on a single tissue block. For example, it is common practice to cut multiple levels from a tissue block and stain each level with the same stain. The multiple levels from the same block of tissue stained with the same stain should not be reported as additional units of service. Only one unit of service should be reported for the stains on multiple levels from the single tissue block. Additionally, controls performed with the special stains should not be reported as separate unit of service for the stain.
For cytology specimens from a single anatomic site only one unit of service may be reported for each special stain regardless of the number of slides from that site stained with the special stain.
For hematology smears only one unit of service may be reported for each special stain regardless of the number of smears from and anatomic site stained with the special stain. For example if multiple smears of peripheral blood are stained with an iron stain, only one unit of service may be reported. Similarly, if three smears from a bone marrow aspirate are stained with an acid fast stain, only one unit of service may be reported. Smears from peripheral blood, one iliac crest, and contralateral iliac crest are from three separate anatomic sites.
The unit of service for the immunohistochemical (IHC) codes 88342, 88360 and 88361 is "per antibody." However, the 2012 CPT code book provides no additional parenthetical instruction regarding coding per block vs. per specimen. The 2012 CMS NCCI edit narratives specifically address this issue:
The unit of service for immunohistochemistry (CPT codes 88342, 88360, 88361) is each antibody(s) stain (procedure) per specimen. If a single immunohistochemical stain (procedure) for one or more antibodies is performed on multiple blocks from a surgical specimen, multiple slides from a cytologic specimen, or multiple slides from a hematologic specimen, only one unit of service may be reported for each separate specimen. Physicians should not report more than one unit of service per specimen for an immunohistochemical antibody(s) stain (procedure) even if it contains multiple separately interpretable antibodies.
This new guidance reverses the special stain policy CMS issued in October 2009, which stated special stains should be billed per block and included codes 88342, 88360 and 88361. The most recent edit narratives clarify the unit of service for immunohistochemical stains to be the stain or the procedure, regardless of the number of antibodies in the procedure. In addition, cocktail stains consisting of multiple antibodies should now be reported with a single unit of the applicable code.
The latest edition of narratives from CMS makes the NCCI edits consistent with guidance published by the AMA in the October 2010 issue of the CPT Assistant:
CPT code 88342, Immunohistochemistry (including tissue immunoperoxidase), each antibody, should be reported twice. It is "each antibody" no matter how many blocks are applied to a given specimen."
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