The adage to ‘always report the most specifc CPT code’ could ensnare your estrogen receptor (ER) and progesterone receptor (PR) coding for breast cases. Here our experts help you sort out the difference between specific analyte and specific method to ensure you select the right code every time.

Reserve 84233 and 84234 for assays

If you are searching for specific codes when a surgical pathology report references estrogen and/or progesterone receptor testing, you should not miss 84233 and 84234. However are those always the correct choice?

The 84233 and 84234 definitions create a confusion for medical coders reporting ER/PR tests. The question is whether you must report 84233/84234 as the definitions specify ER/PR, or if you can in its place report a generic immunohistochemistry code such as 88342 for certain ER/PR testing.

Codes 84233 and 84234 describe laboratory tests for estrogen and progesterone receptors that use a biochemical ligand-binding assay method like dextran-coated charcoal assay. However most labs evaluate ER/PR using immunohistochemistry as clinical studies have consistently shown the superiority of immunohistochemistry over biochemical assay methods for ER/PR testing.

Watch out for immunohistochemistry (IHC)

When the lab method involves immunohistochemistry for tissue specimens like evaluating breast tumors for ER and PR status, you should look to the following codes to describe the service: 88342, 88360, 88361.

Although these code definitions are ‘generic’ in the sense that they do not specifically identify estrogen or progesterone receptors, you should report them for an ER or PR (or any other) immunohistochemistry antibody strain.

Differentiate qualitative/quantitative codes

Choosing among 88342, 88360, or 88361 calls for knowing whether the immunohistochemistry analysis is qualitative or quantitative and whether quantification uses computer-assisted technology or “manual” counting, including visual approximation. You might choose to go for any of these three codes for ER, PR, Her- 2/neu, Ki-67, or any of various other IHC analyses

Count antibodies

You should report one unit of the right code for each antibody stain, irrespective of which antibody you are coding.

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