Reprinted from June 2000 CAP TODAY
Q: We perform HER-2/neu detection by the FISH method. What code should
pathologists use to report the quantification? And should we use codes
84233 and 84234 for estrogen and progesterone assay detection on breast
A: If testing for HER-2/neu by FISH, use 88365, Tissue in situ hybridization,
interpretation and report. If quantification is performed, use morphometry
code 88358, Morphometric analysis; tumor.
If you are performing estrogen or progestrone receptor assay detection
on a tissue specimen via immunocytochemistry, use code 88342, Immunocytochemistry
(including tissue immunoperoxidase), each antibody. Morphometry code
88358 may also be indicated for quantification. Codes 84233, Receptor
assay; estrogen, and 84234, Receptor assay; progesterone, are
for traditional estrogen and progesterone laboratory assays.
Q: I heard that pathologists can use 80500, Clinical pathology
consultation; limited, without review of patient’s history and medical
record, when they review Pap tests and histology slides to determine
the cause of discrepancies. Is this correct?
A: Yes. In 1995 the American Medical Association's CPT Editorial Panel
advised the CAP that pathologists should use 80500 for review of cytopathology
smear and histopathology slides to determine the cause of discrepancies.
The article, “New use for CPT 80500”
(CAP TODAY, March 1996, page 78), further elaborated that code
80500 can be used when the service, “is provided to determine the
reason for the discordance so further studies can be suggested or a clinical
course of action can be determined, not for the purpose of quality control
of the previously interpreted smears.” Code 80500 should be reported
when reviewing material from within the same institution. Use 88321, Consultation
and report on referred slides prepared elsewhere, to report slides
submitted from another institution.
Code 80500 is a clinical consultation code. CPT notes that to use 80500
or 80502, the consultation must be requested by the patient’s attending
physician in relation to a test result(s) requiring medical interpretive
judgment and must result in a written report by the pathologist.
Section 15020 of the Medicare carriers manual lists four conditions that
must be met in order to use codes 80500 and 80502. Clinical consultations
are paid for Medicare patients under the physician fee schedule only if
- are requested by the patient’s attending physician;
- relate to a test result that lies outside the clinically significant
normal or expected range in view of the condition of the patient;
- result in a written narrative report included in the patient’s medical
- require the exercise of medical judgment by the consultant physician
Recently, HCFA instructed Medicare carriers not to recognize standing
orders for clinical pathology consultations (80500-80502). Each clinical
pathology consultation must be requested by the attending physician.
Frequently asked questions about CPT are published bimonthly in “Capitol
Scan.” This addition to CAP TODAY is a product of the CAP Economic
The codes and descriptions listed here are from Current Procedural Terminology,
a copyrighted publication of the American Medical Association. To purchase
CPT books, call the AMA at (800) 621-8335.