Print Article

March 2011
The essential resource for your practice
Volume XXI, Number 3
Table of Contents

  

New Fluorescence In Situ Hybridization (FISH) Codes Created for Urinary Tract Specimens

Effective January 1, 2011, two new Current Procedural Terminology (CPT®) codes, 88120 Cytopathology, in situ hybridization (eg, FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; manual and 88121 Cytopathology, in situ hybridization (eg, FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; using computer-assisted technology are available to report the FISH test for bladder cancer. FISH DNA probe technology can be used to detect chromosomal abnormalities in urinary tract specimens, aiding in the identification of bladder cancer and bladder cancer surveillance.

History of the new codes

In 2007, a Medicare contractor noticed a significant increase in utilization in the 88367 Morphometric analysis, in situ hybridization (quantitative or semi-quantitative) each probe; using computer-assisted technology/88368 Morphometric analysis, in situ hybridization (quantitative or semi-quantitative) each probe; manual . Pathologists were reporting these codes four times because four molecular probes were used in the FISH test for bladder cancer. The original vignette for CPT® codes 88367/88368 described the use of FISH in the identification of the HER2 gene for breast cancer and either code was billed one time only. The Centers for Medicare & Medicaid Services (CMS) then notified the College of American Pathology (CAP) to either re-value existing CPT® codes or develop two new CPT® codes for the FISH for urinary tract describing the use of three to five probes.

Because the FISH test of the urinary tract was different than the original codes listed above, CAP requested two new CPT® codes for FISH urinary tract specimens for bladder cancer. The FISH of the urinary tract uses four probes to identify chromosomes 3, 7, 17 and the 9p21 gene locus instead of one probe, which was the original intent of the vignette for CPT® codes 88367/88368. The new CPT® codes for urinary tract specimen include the use of 3-5 probes. 

The proposed codes were presented to the Pathology Coding Caucus by CAP in May 2009 and approved by the CPT® Advisory Panel in June 2009. The codes were then valued through the American Medical Association (AMA)/Specialty Society Relative Value Update Committee (RUC) in October 2009 to become effective in January 2011.

Pathologists perform and interpret this test, so urology was not involved in the submission process for new CPT® codes or the process of determining the work values for these codes through the RUC.

Reporting FISH for urinary tract specimen

To report the FISH test provided on or after January 1, 2011, for bladder cancer, use:

 88120 Cytopathology, in situ hybridization (eg, FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; manual

 88121 Cytopathology, in situ hybridization (eg, FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; using computer-assisted technology

CPT® codes 88120 or 88121 can only be reported one time per test kit (three to five probes) no matter whether they are billed by a pathology practice or a urology practice that employs a pathologist.

If more than five probes are used, then the unlisted code 88399 Unlisted surgical pathology procedure should be reported.