How To Use CPT Code 88364

CPT 88364 refers to the additional in situ hybridization (ISH) procedure, specifically for each extra single probe stain applied to a specimen. This code is utilized in conjunction with the primary procedure code 88365, which covers the initial single probe stain. The application of this code is particularly relevant in the context of cancer diagnostics, where multiple probes may be necessary to identify specific genetic markers within tumor tissues. The process involves a lab analyst preparing slides from patient specimens and applying additional stains, which are then interpreted by a qualified pathologist to aid in diagnosis and treatment planning.

1. What is CPT code 88364?

CPT code 88364 represents the procedure of applying an additional single probe stain during an in situ hybridization test, specifically for specimens that have already undergone an initial probe stain as described by CPT code 88365. This procedure is crucial in the field of pathology, particularly in oncology, as it allows for the identification and localization of specific genes within tumor tissues. The use of ISH, particularly fluorescence in situ hybridization (FISH), enables pathologists to visualize genetic abnormalities that may be indicative of certain cancers, such as breast or cervical cancer. The qualitative interpretation of these stains is essential for accurate diagnosis and subsequent treatment decisions.

2. Qualifying Circumstances

The use of CPT code 88364 is appropriate when an additional single probe stain is applied to a specimen that has already been subjected to an initial probe stain under code 88365. It is important to note that this code should only be reported for qualitative ISH stains, and not for quantitative or semiquantitative analyses, which fall under different codes (88367 to 88377). Additionally, if the pathologist counts or estimates the number of stained cells, this code should not be used. The code is not applicable for multiplex stains, which involve multiple antibodies, and should not be reported for cytology specimens related to bladder cancer or for heritable diseases, where other specific codes apply.

3. When To Use CPT 88364

CPT code 88364 is used when a lab analyst performs an additional single probe stain on a specimen that has already been tested with an initial probe stain (CPT 88365). It is essential to report this code for each additional probe stain applied, regardless of the number of slides or blocks prepared. The code is considered an add-on, meaning it cannot be billed independently; it must accompany the primary code 88365. If billing only for the technical work performed by the lab analyst, modifier TC should be appended, while modifier 26 should be used if billing solely for the professional interpretation by the pathologist. This code is not applicable for multiplex stains or for certain cytology specimens, which require different coding.

4. Official Description of CPT 88364

Official Descriptor: In situ hybridization (eg, FISH), per specimen; each additional single probe stain procedure (List separately in addition to code for primary procedure).

5. Clinical Application

CPT code 88364 is applied in the clinical setting primarily for the diagnosis of cancers through the use of in situ hybridization techniques. The procedure allows for the detection of specific genetic markers within tumor tissues, which can provide critical information regarding the tumor’s characteristics and behavior. This information is invaluable for clinicians in making informed decisions about treatment options and patient management. The ability to apply multiple single probe stains enhances the diagnostic capabilities of pathologists, allowing for a more comprehensive analysis of the specimen.

5.1 Provider Responsibilities

The provider’s responsibilities during the application of CPT code 88364 include the preparation of the specimen slides, which involves cutting and mounting the tissue onto slides and applying the necessary reagents for staining. The lab analyst then applies the additional single probe stain to the prepared slides. Following this, a qualified pathologist examines the stained slides under a microscope, qualitatively interpreting the results to reach a pathologic diagnosis. The pathologist is also responsible for documenting the findings in a report for the ordering clinician.

5.2 Unique Challenges

One of the unique challenges associated with the use of CPT code 88364 is ensuring the accuracy and specificity of the additional probe stains applied. The lab analyst must be meticulous in preparing the slides and applying the stains to avoid cross-contamination or misinterpretation of results. Additionally, the pathologist must be skilled in interpreting the findings from multiple stains, as the presence of various markers can complicate the diagnostic process. The complexity of the staining process and the need for precise interpretation can impact the overall delivery of the service.

5.3 Pre-Procedure Preparations

Before performing the procedure associated with CPT code 88364, the provider must ensure that the initial specimen has been properly prepared and stained using the primary code 88365. This includes verifying that the specimen is suitable for ISH testing and that all necessary reagents and equipment are available for the additional staining process. The provider may also need to review the patient’s clinical history and any previous test results to inform the interpretation of the additional stains.

5.4 Post-Procedure Considerations

After the application of CPT code 88364, the pathologist must carefully monitor the results of the additional probe stains and document the findings in a comprehensive report. Follow-up may be required to discuss the results with the ordering clinician, especially if the findings have significant implications for the patient’s diagnosis or treatment plan. Additionally, the lab may need to maintain records of the staining process and results for quality assurance and compliance purposes.

6. Relevant Terminology

Hybridization: The process of forming a double-stranded DNA or RNA molecule by combining two complementary single strands, typically used to identify genetic mutations.

Reagent: A substance used in laboratory tests to induce a desired change or reaction, often to reveal the presence or quantity of another substance being tested.

7. Clinical Examples

1. A patient with a suspected breast tumor undergoes an initial ISH test to identify HER2 gene amplification, followed by an additional probe stain to assess the presence of the estrogen receptor gene.

2. In a case of cervical cancer, a pathologist applies an additional probe stain to detect the presence of HPV-related genetic markers after the initial stain.

3. A lab analyst prepares slides from a lung cancer specimen and performs an additional ISH test to identify mutations in the EGFR gene.

4. A patient with a history of bladder cancer has a tumor specimen analyzed, and the pathologist applies an additional probe stain to further characterize the tumor’s genetic profile.

5. Following an initial ISH test for a sarcoma, the lab analyst applies a second probe stain to assess the presence of a specific chromosomal abnormality.

6. A patient diagnosed with leukemia has a bone marrow specimen tested with an initial probe stain, followed by an additional stain to identify specific genetic deletions.

7. In a case of ovarian cancer, the pathologist uses an additional probe stain to evaluate the presence of BRCA1 mutations after the initial analysis.

8. A lab analyst prepares a specimen from a melanoma case and performs an additional ISH test to detect mutations in the BRAF gene.

9. A patient with a rare genetic disorder undergoes an ISH test, and the lab analyst applies an additional probe stain to identify specific chromosomal abnormalities.

10. After an initial ISH test for a gastrointestinal tumor, the pathologist applies an additional probe stain to further investigate the tumor’s genetic characteristics.

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