Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
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Breast Cases: Pathology Charges
In our practice, some of the special immunostains (IHC) and genomic studies may be performed at one of several distant reference labs PhenoPath, Impath, Genomics Health Lab, or Clarient). Until about 2000, one group member who prefers to have his IHC stains for ER, PR, and HER-2 performed and interpreted by Impath Lab (a for-profit, publicly-traded stock company). Because we cannot yet (as of 4/08) perform FISH tests in our lab, we send requests for HER-2 by the FISH technique to PhenoPath lab (a professional pathology practice). We have no control over the charges filed by any such reference lab, but we feel that they are likely to consider special circumstances which are conveyed courteously & in good faith.
Specimen CPT-4 code Charge Reasoning

2nd opinion, intra-departmental
consultation

88323

no charge

we chose not to charge (there are 7 doctors in our group and the cases often have 3-4 additional 2nd opinions...IPCs). A common event.
FNA needle aspirate performed by pathologist or any other health care provider 10021 full charge  
FNA needle aspirate, performing doctor assisted by pathologist; in lab, X-ray or OR intra-operative consult, help, advisory by pathologist to a clinician provider performing the FNA 88329 usually not charged as of 5/2006 uncommon in breast cases
FNA needle aspirate, pathologist immediately reviews smear for adequacy 88172 full charge only, maybe, when pathologist performs the procedure; sometimes for radiologist
FNA needle aspirate, cytology diagnosis 88173 full charge the specimen for a true breast FNA would be slides & not fluid
core biopsy (s), per each separately labeled specimen 88305 full charge uncommon to have more than one separately labeled specimen
frozen section (FS) 88331 full charge there could be more than one per operative case
each additional FS block on a given specimen 88332 full charge rare to have more than 1 block in a breast FS
touch prep cytology, intra-operative, std. Pap or H&E stain 88160 (not code as of 2006) none uncommonly utilized, so far, in breast cases; cannot use within same procedure for 88173
Wright's special stain on touch prep when lymphoma suspected 88313 full charge rare in breast cases
flow cytometry   charged by the reference lab rare in a breast case; pathologist would suspect it from the way the fresh specimen looks, or with intra-operative cytology preps; sample would be sent to P-RMH who would bill for services
benign incisional biopsy 88305 full charge surgery partly removes the tumor
malignant incisional biopsy 88305 full charge surgery partly removes the tumor
benign excisional biopsy 88305 full charge  
malignant excisional biopsy 88305 full charge  
lumpectomy for diagnosis and margin interpretation 88307 full charge  
additional lumpectomy margin 88305 full charge as of 5/06  
completion lumpectomy, no margin analysis 88305 full charge  
completion lumpectomy,  margin analysis 88307 full charge  
completion lumpectomy amounts to a partial mastectomy 88307 full charge  
simple mastectomy, total or partial 88307 full charge  
radical mastectomy, with or without non-precisely identified node sampling or dissection 88309 full charge  
sentinel lymph node 88307 full charge  
a lymph node biopsy 88305 full charge  
lymph node sampling or dissection in a separate container 88307 full charge if removed at the time of 88309 mastectomy, only the mastectomy is charged (the nodes get "bundled" with the mastectomy)
skin biopsy 88305 full charge as of 5/06  
IHC stain for ER 88342 full charge all invasive cases; some CIS
IHC stain for PR 88342 full charge all invasive cases
IHC stain for HER-2 88342 full charge all invasive cases
IHC stain for Ki67 88342 full charge all invasive cases
IHC stain (s) to rule in/out invasion 88342 full charge occasionally needed
IHC stain to rule in/out lobular cancer 88342 full charge occasionally needed
a histochemical special stain to help rule in lobular; or as many 4 different stains for infections; or a stain for such as amyloid 88313 full charge rarely needed
IHC stain on nodes for occult mets 88342 full charge almost always only one charge per case unless there is a separately labeled sentinel node and then other separately labeled  lymph nodes
IHC stains at ref. lab 88342   you'd get a bill from PhenoPath Lab in Seattle
FISH through our LML     you'd get a bill from us
OncotypeDX genomic analysis     Our pathologist must pick out the best piece to send & has to review results for concordance with IHC & other tumor findings
review of ref. lab's IHC stains 88323   our local pathologist reviews ref. lab's (Impath, Clarient) slides to make sure no discordances & to interpret
reduction mammoplasty (or mastopexy) cases use 883051 right 88305
left 88305
we do about a case per weekday to check for any occult precancerous lesions
male breast surgery for gynecomastia 88307-2 60% reduced if  benign  
FISH stain for HER-2 coded by the reference lab you are billed by the ref. lab performed at PhenoPath Lab, Seattle
a requested second-opinion case review by us 88321, 88323, or 88325 full charge uncommon
review of your cases slides on a recent/previous surgery or biopsy elsewhere 88323 varies, reduced to full we do this about once per week
review of your case's slides on a recent/previous surgery or biopsy at one of the Lexington facilities in connection with sending for special studies or solving questions from Breast Cancer Conference 88321 varies, no chrge vs. reduced to full uncommon

References:

  1. Pathology/Lab Coding Alert 3(12):96, Dec 2002

(posted 7 June 2002; some revisions 4 May 2008)
 
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