How To Use CPT Code 88365

CPT 88365 describes the initial single probe stain procedure for in situ hybridization (ISH), which is used to detect and localize specific DNA or RNA segments in patient tissue. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 88365?

CPT 88365 can be used to describe the initial single probe stain procedure for in situ hybridization (ISH). This procedure involves applying a specialized stain to slides prepared from a patient specimen, such as tumor tissue. The stain includes a DNA or RNA probe that selectively attaches to a target segment of DNA or RNA in the tissue. A qualified provider, typically a pathologist, then interprets the stained slides to provide a pathologic diagnosis.

2. Official Description

The official description of CPT code 88365 is: ‘In situ hybridization (eg, FISH), per specimen; initial single probe stain procedure.’

3. Procedure

1. The lab analyst prepares slides from a patient specimen, such as tumor tissue, using a specialized stain process called in situ hybridization (ISH).
2. A DNA or RNA probe, which selectively attaches to a target segment of DNA or RNA in the tissue, is applied to the slides.
3. The lab analyst visualizes the probe using a fluorescence microscope to detect and localize the target in the tissue.
4. The pathologist qualitatively interprets the stained slides under the microscope to reach a pathologic diagnosis.
5. The pathologist prepares a report for the ordering clinician based on their interpretation of the stained slides.

4. Qualifying circumstances

CPT 88365 is typically performed to aid in the diagnosis of certain cancers. However, it can also be used for other conditions, such as heritable diseases associated with deletions or chromosome abnormalities. The procedure requires a qualified provider, usually a pathologist, to interpret the stained slides and provide a pathologic diagnosis.

5. When to use CPT code 88365

CPT code 88365 should be used for the initial single probe stain procedure for in situ hybridization (ISH). It is important to note that this code is for qualitative ISH stains only. If the lab analyst performs additional single probe stains on slides from the same specimen, each additional stain should be reported using code 88364. For multiplex probe stains, code 88366 should be used instead.

6. Documentation requirements

To support a claim for CPT 88365, the following documentation is required:

• Details of the patient specimen, such as tumor tissue
• Description of the specialized stain process used, including the DNA or RNA probe
• Date of the procedure
• Qualitative interpretation of the stained slides by the pathologist
• Pathologic diagnosis based on the interpretation
• Report prepared by the pathologist for the ordering clinician

7. Billing guidelines

When billing for CPT 88365, it is important to report the code without a modifier to describe both the technical work performed by the lab analyst and the professional work performed by the pathologist. If billing only for the technical work, modifier TC should be appended to the code. If billing only for the professional work, modifier 26 should be appended to the code. It is also important to note that CPT 88365 should not be reported with codes in the range 88367 to 88377, which are used for quantitative or semiquantitative ISH.

8. Historical information

CPT 88365 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A pathologist performing the initial single probe stain procedure for in situ hybridization (ISH) on slides prepared from a patient’s tumor tissue to detect and localize specific DNA segments.
2. A lab analyst applying a specialized stain to slides prepared from a patient specimen, such as tumor tissue, for the initial single probe stain procedure for in situ hybridization (ISH).
3. A pathologist interpreting stained slides under a fluorescence microscope to qualitatively assess the presence and localization of specific RNA segments in a patient’s tissue.
4. A lab analyst preparing slides from a patient specimen, such as tumor tissue, and applying a DNA probe for the initial single probe stain procedure for in situ hybridization (ISH).
5. A pathologist providing a pathologic diagnosis based on their interpretation of stained slides prepared from a patient’s tumor tissue using the initial single probe stain procedure for in situ hybridization (ISH).
6. A lab analyst visualizing a DNA probe using a fluorescence microscope to detect and localize specific DNA segments in a patient’s tissue during the initial single probe stain procedure for in situ hybridization (ISH).
7. A pathologist preparing a report for the ordering clinician based on their qualitative interpretation of stained slides prepared from a patient’s tumor tissue using the initial single probe stain procedure for in situ hybridization (ISH).
8. A lab analyst performing the technical steps to prepare stained slides from a patient specimen, such as tumor tissue, for the initial single probe stain procedure for in situ hybridization (ISH).
9. A pathologist interpreting stained slides under a microscope to qualitatively assess the presence and localization of specific RNA segments in a patient’s tissue during the initial single probe stain procedure for in situ hybridization (ISH).
10. A lab analyst applying a specialized stain to slides prepared from a patient specimen, such as tumor tissue, and visualizing a DNA probe using a fluorescence microscope during the initial single probe stain procedure for in situ hybridization (ISH).