Can Your LIS and RCM Systems Work Together to Automate Reimbursement for IHC Tests?

There are many complex rules around the billing of immunohistochemistry (IHC) and other anatomic pathology (AP) tests, especially when multiple specimens are tested for the same patient on the same date of service. Understanding the unit of service for these tests is important in proper billing and thus full reimbursement. The unit of service for immunohistochemistry and immunocytochemistry (ICC) is each single or multiplex antibody stain procedure per specimen.

There are different CPT codes for each unit of service:

• One CPT code, 88342, is used per specimen for an IHC or ICC initial single antibody stain procedure (i.e. the primary procedure)
• A different CPT code, 88341, is used per specimen for IHC or ICC for each additional single antibody stain procedure, listed separately and in addition to CPT code 88342 for the primary procedure
• CPT Code 88344 is used for per specimen for IHC or ICC for each multiplex antibody stain procedure

Being able to bill these tests correctly and receive full reimbursement is dependent on the specimen-specific unit of service being passed from the laboratory information system (LIS) to the revenue cycle management (RCM) system. In addition, there are limits on the number of test codes that can be billed per day, further complicating the billing scenarios. Most RCM systems have a very difficult time automating these complex billing scenarios, and as a result, labs need to have manual workarounds in place, which slow down the reimbursement process and are prone to error.

For laboratories that use both XiFin LIS and XiFin RPM, this process is much easier. XiFin LIS can pass a code to XiFin RPM through a web service call, and XiFin RPM has rules in place that enable it to automate the billing process for IHC, ICC, and other AP tests with multiple specimens. We are also working on new methods that will make this process even easier. In the near future, XiFin LIS will be able to pass the specific specimen code to XiFin RPM, making this process even more robust. 

Using XiFin LIS and XiFin RPM together helps laboratories cost-effectively maximize reimbursement for IHC and ICC tests, while at the same time managing compliance.

To learn more about integrating your LIS system with your RCM system, read the blog post, “Benefits of RCM and LIS Integration.”