HCPCS Codes: IHCP Implements Audit

Effective June 1, 2014, the Indiana Health Coverage Programs (IHCP) will implement an audit to ensure HCPCS codes G0461 – Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain and G0462 – Immunohistochemistry or immunocytochemistry, per specimen; each additional single or multiplex antibody stain (list separately in addition to code for primary procedure) cannot be billed for the same date of service (DOS) with the following CPT codes:

• 88342 – Immunohistochemistry or immunocytochemistry, each separately identifiable antibody per block, cytologic preparation, or hematologic smear; first separately identifiable antibody per slide
• 88343 – Immunohistochemistry or immunocytochemistry, each separately identifiable antibody per block, cytologic preparation, or hematologic smear; each additional separately identifiable antibody per slide

Providers will receive explanation of benefits (EOB) 9126 – G0461 and G0462 cannot be reported with procedure codes 88342 or 88343 if they bill these codes for the same DOS.