Article ID Number: A57661 Status: A-Approved
Article Title: Billing and Coding: MDS FISH
Original Article Effective Date:
Revision Effective Date:
The information in this article contains billing, coding, or other guidelines that complement the Local Coverage Determination (LCD) for MDS FISH L37620.
Coding for FISH Testing
There are 2 sets of codes that describe in situ hybridization (ISH). Although the laboratory methods are similar, one distinguishes between the 2 sets of codes based on whether the ISH test is an adjunct to a surgical or cytopathology case, versus whether it is part of a clinical, chromosomal analysis. Specifically, the CPT® codes 88271-88291 should be used when the laboratory performs ISH as an ancillary analysis to cytogenetic studies for oncologic or inherited disorders.
When a pathologist performs ISH techniques as an adjunct to a surgical pathology or cytopathology case, CPT® codes 88365-88377 should be used to distinguish qualitative versus quantitative analysis (computer assisted versus manual). These codes must never be used by a pathologist when ISH is performed as an ancillary analysis to cytogenetic studies.
To report an MDS FISH service, please submit the following claim information:
- Select the appropriate CPT® code
- Enter 1 unit of service (UOS)
- Select the appropriate ICD-10-CM code
A DEX Z-Code™ identifier is not required for FISH testing. If submitting a DEX Z-Code™ identifier, please submit following the below instructions:
- Enter the appropriate DEX Z-Code™ identifier adjacent to the CPT® code in the comment/narrative field for the following Part B claim field/types:
- Loop 2400 or SV101-7 for the 5010A1 837
- Item 19 for paper claim
- Enter the appropriate DEX Z-Code™ identifier adjacent to the CPT® code in the comment/narrative field for the following Part A claim field/types:
- Line SV202-7 for 837I electronic claim
- Block 80 for the UB04 claim form