G2 Compliance Corner

by G2 Intelligence Staff | Feb 23, 2015 | CMS-lca, Compliance Corner-lca, Essential, Lab Compliance Advisor

We are trying to figure out how to code immunohistochemistry stains using the new codes that will be available in 2014, 88342 and 88343. We are also confused about how the two new Medicare “G” codes (G0461 and G0462) will be used. In CPT 2014, the definition for 88342 was revised from, “Immunohistochemistry (including tissue immunoperoxidase), each antibody” to “Immunohistochemistry or immunocytochemistry, each separately identifiable antibody per block, cytologic preparation, or hematologic smear; first separately identifiable antibody per slide.” The American Medical Association also created a new add-on code 88343, “Immunohistochemistry or immunocytochemistry, each separately identifiable antibody per block, cytologic preparation, or hematologic smear; each additional separately identifiable antibody per slide (list separately in addition to code for primary procedure).” CMS had concerns about overutilization of these codes so it created two “G” codes and defined the unit of service as “per specimen”: G0461 Immunohistochemistry or immunocytochemistry, per specimen; first separately identifiable antibody; and G0462 Immunohistochemistry or immunocytochemistry, per specimen; each additional separately identifiable antibody (List separately in addition to code for primary procedure). Thus, in 2014 for non-Medicare patients, same stain on multiple blocks (same specimen) on same date of service, you should code 88342 for the first separately […]

We are trying to figure out how to code immunohistochemistry stains using the new codes that will be available in 2014, 88342 and 88343. We are also confused about how the two new Medicare “G” codes (G0461 and G0462) will be used. In CPT 2014, the definition for 88342 was revised from, “Immunohistochemistry (including tissue immunoperoxidase), each antibody” to “Immunohistochemistry or immunocytochemistry, each separately identifiable antibody per block, cytologic preparation, or hematologic smear; first separately identifiable antibody per slide.” The American Medical Association also created a new add-on code 88343, “Immunohistochemistry or immunocytochemistry, each separately identifiable antibody per block, cytologic preparation, or hematologic smear; each additional separately identifiable antibody per slide (list separately in addition to code for primary procedure).” CMS had concerns about overutilization of these codes so it created two “G” codes and defined the unit of service as “per specimen”:

G0461 Immunohistochemistry or immunocytochemistry, per specimen; first separately identifiable antibody; and

G0462 Immunohistochemistry or immunocytochemistry, per specimen; each additional separately identifiable antibody (List separately in addition to code for primary procedure).

Thus, in 2014 for non-Medicare patients, same stain on multiple blocks (same specimen) on same date of service, you should code 88342 for the first separately identifiable antibody in a specimen or block and then 88343 for each additional antibody in additional blocks. For 2014, for Medicare patients, same stain on multiple blocks (same specimen) on same date of service, bill G0461 one time regardless of the number of blocks because the descriptor says “per specimen.” If a second stain is required to identify another antibody, code the second stain with G0462.

G2 Compliance Corner

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