Four Tips Crack The Tissue Selection Code

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Until now, when your pathologist examined and chose previously diagnosed tissue for molecular analysis, you did not have a code to capture the service.


However CPT 2011 now gives you the ability to get paid for this service by adding 88363 (Examination and selection of retrieved archival [that is, previously diagnosed] tissue[s] for molecular analysis [example, KRAS mutational analysis]). Based on the Medicare physician fee schedule national facility total amount using conversion factor 33.9764, your practice could recover $38.05 for the procedure.


Here are some tips to help you learn when and how to code for this service:


Pathologist must choose material


Just retrieving an archive case report, blocks, and/or slides from storage is not enough to warrant an 88363 charge.


In order to use the code, the pathologist must identify and choose proper tumor tissue from previous surgical specimen. This identification and selection is seriously required for the success of subsequent gene mutation analysis.


To ...
... put it in other words, the pathologist must exercise medical judgment in choosing archival tissue for subsequent molecular analysis before you can code 88363. The pathologist will also in general review the initial report and start any necessary block or slide preparation of the chosen tissue to move forward for molecular testing.


Whether to send out or not: You can report 88363 whether an in-house molecular lab or an outside reference laboratory will carry out the molecular analysis. If you carry out the test in house, be careful of potential conflict with microdissection codes, as you'll see in 88380 and 88363.


KRAS is example test


You can report 88363 when your pathologist chooses archive tissue for "molecular analysis,"which includes a wide range of testing. By listing KRAS using e.g. in parenthesis, CPT indicates that selection for KRAS is only an instance - selection for other tests might warrant the code as well.


Define 'molecular analysis': Surely any molecular test that is properly described by codes in the 83890-83914 range (Molecular diagnostics) would qualify for application of 88363 when demanded by the circumstances.


Even though you may be able to report 88363 to describe archive specimen tissue selection for tests such as molecular cytogenetics and in situ hybridization, CPT does not provide specific direction on the matter.


Watch units: Most probably you should use 88363 for each archive specimen examination/selection episode, irrespective of the number of molecular tests that follow.


Report 88363 for 'Signed Out' cases


The use of "archival"in the code definition has brought forward some confusion for coders.


Days don't matter: The number of days between the original case and the 88363 service is not the main factor in determining if it's proper to use 88363. Do not confuse CPT's use of the term "archival tissue(s)"with Medicare's definition of an "archived specimen"associated with DOS determination-- the two terms are not the same.


For purposes of CPT code 88363, the case is "archival"when the pathologist has released the case report and sent the slides/tissues to be stored. This means you shouldn't use 88363 if the pathologist or treating doctor decides to prep tissue for a molecular test such as KRAS before the pathologist completes the primary case and signs it out.


Stay away from modifiers TC/26


Even though 88363 involves a TC and PC, you should not code with modifiers TC and 26.


Reason: The Medicare physician fee schedule does not allow modifiers TC and 26, but then provides a higher payment rate for non-facility (non-hospital patient) versus facility (hospital patient). The payment difference represents the TC of the service such as sectioning blocks chosen by the pathologist for molecular testing. Likewise, the Medicare outpatient prospective payment APC fee schedule lists a payment rate for 88363, which accounts for the technical work the hospital provides for the service for an outpatient.


When an independent lab supports the pathologist's work and uses 88363 with place of service 11 (Medical office) or 81(Independent lab) on its Form CMS-1500 claim, the lab will get the higher non-facility payment.


A hospital that is due payment for the technical support of the pathologist's 88363 work will be paid through the outpatient prospective payment system APC fee schedule upon filing Form CMS-1450 (UB-04) with its Part A contractor.


For more on this and for other specialty-specific articles to assist your pathology coding, sign up for a good medical coding resource like Coding Institute.