2025 CPT code 88369
(Active) Effective Date: N/A Pathology and Laboratory Procedures - Surgical Pathology Procedures Feed
Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each additional single probe stain procedure.
Modifiers 26 (Professional Component) and TC (Technical Component) can be used with this code if billing separately for the professional or technical aspects of the service.
The medical necessity for this procedure must be documented and should be linked to the diagnosis and treatment plan for the patient's condition. Payer-specific guidelines for medical necessity should be followed.
The lab analyst performs the technical aspect of preparing and staining the slides. The pathologist is responsible for interpreting the stained slides, manually counting or estimating the probes, and reporting the findings to the ordering clinician.
In simple words: This test involves applying an additional special stain to a tissue sample to help diagnose certain cancers. It's used after an initial stain has already been done. A pathologist then examines the stained sample under a microscope to count and locate specific markers, helping doctors better understand the cancer and plan treatment.
This code represents an additional in situ hybridization (ISH) single probe stain procedure performed on a specimen, following an initial probe stain. It involves applying a different single probe stain than the first one (88368), which is then manually evaluated by a pathologist, including counting or estimating the number and location of probes. This procedure is typically used in conjunction with the primary procedure code 88368 and aids in the diagnosis of certain cancers by detecting and localizing specific genes in tumor tissue.
Example 1: A patient has a breast biopsy. After the initial ISH probe stain (88368), an additional probe stain is needed to further evaluate the tumor cells, so 88369 is reported., A patient has a cervical biopsy. After performing 88368, an additional probe stain is required to assess the expression of a different gene of interest, so 88369 is reported., A patient undergoes a biopsy for suspected bladder cancer. If a second single probe ISH stain is performed after 88368 on the same specimen, 88369 is billed in addition to 88368.
Documentation should include the type of specimen, the initial probe stain performed (88368), the reason for the additional stain (88369), the manual counting or estimation of probes, and the pathologist's interpretation.
** This information is current as of December 10, 2024. Coding and billing regulations are subject to change, so it's always important to refer to the latest guidelines for accurate and up-to-date information.
- Modifier TC rule: Modifier TC can be applied if only the technical component of the test is being billed.
- Specialties:Pathology, Oncology, possibly other specialties depending on the specific clinical scenario.
- Place of Service:Independent Laboratory, Outpatient Hospital, possibly other places of service depending on where the test is performed.