Match Diagnosis to Findings and Discover Dividing Line for ISH Codes

Question: An ob-gyn gave 3 cm sections of right and left fallopian tubes along with a surgical note demonstrating that he removed the tissue as part of a routine sterilization procedure. Your pathologist found indication of malignant neoplasm, though. What would be the correct ICD-9 and CPT codes for this case?

Answer: You must assign the diagnosis founded on the pathologist's findings rather than the surgical report. In place of using the ICD-9 code signifying that the surgeon submitted the fallopian tubes from a sterilization procedure (V25.2,Sterilization), you must use the code that specifies your pathologist's findings. In this case, you must list 183.2 (Malignant neoplasm of fallopian tube).

Here's why: The ICD-9-CM Official Guidelines for Coding and Reporting for both inpatients as well as outpatients state that you must code a definite or definitive diagnosis provided by a physician --in this situation, the pathologist.

ICD-9 and CPT Coding Tip: This case points at a significant consideration -- the diagnosis can have an effect on the pathology procedure code in some conditions. As the pathologist inspects the fallopian tubes for cancer, you must report the service as 88305 (Level IV- Surgical pathology, gross and microscopic examination, Fallopian tube, biopsy) in place of 88302 (Level II -- Surgical pathology, gross and microscopic examination, Fallopian tube, sterilization).

Discover Dividing Line for ISH Codes

Question: When your lab carries out ISH procedures, you have PhD scientists who provide the results of the test. You've been told that if your physician medical director evaluates a certain percentage of cases, that you can use the 88367 in place of 88271 codes. Is that correct, and if so, what is the required percentage of cases?

Answer: There is no standard percentage of physician (medical director) review that lets you to report in situ hybridization (ISH) performed by a PhD scientist by means of physician codes.

ICD-9 and CPT Coding Tip: Based on CMS and AMA direction for using the codes in question, you can go ahead and report 88365 (In situ hybridization [e.g., FISH], each probe) and 88367-88368 (Morphometric analysis, in situ hybridization [quantitative or semi-quantitative] each probe …) simply in case a physician (MD or DO) carries out the interpretation. In case a FISH test is carried out by a PhD without a pathologist interpretation, you should use codes from the series 88271-88275 (Molecular cytogenetics …).

Fee schedule hint: Medicare essentially pays for 88365-88368 on the physician fee schedule, however pays for 88271-88275 on the clinical lab fee schedule "http://www.supercoder.com/coding-tools/fee-schedules ". The payment schedules help differentiate physician services from lab services carried out without a direct physician diagnostic interpretation and medical decision making.