Your CPT Questions

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 tissue?

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 they:

1. are requested by the patient’s attending physician;
2. relate to a test result that lies outside the clinically significant normal or expected range in view of the condition of the patient;
3. result in a written narrative report included in the patient’s medical record; and
4. 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.

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.