Description of 88363 CPT code
88363 Examination and selection of retrieved archival (ie, previously diagnosed) tissue(s) for molecular analysis (eg, KRAS mutational analysis)
Mutations (changes) in the KRAS gene are often found in certain human cancers and may be predictive of a poor prognosis and limited clinical response to certain therapies. The KRAS protein is involved in cell growth, cell signal pathways, and cell death. This code reports the examination and selection of previously diagnosed tissues for KRAS mutation analysis in tumor types found to harbor KRAS mutations. Specimen may be formalin-fixed, paraffin-embedded block, unstained slides, or fresh snap frozen biopsy.
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CPT code 88363 was created to capture the pathologist’s findings following the identification and selection of appropriate tumor tissue from a previously diagnosed surgical pathology case.
The descriptor for code 88363 specifically refers to “retrieved archival” tissue or tissues. Per the AMA’s Current Procedural Terminology (CPT), the definition of “archival” when referring to this code, is when the case report and slides/tissue are signed out and released to be stored. It is not Medicare’s definition of an “archived” specimen which is “older than 30 days.”
CPT Code 88363 is reported once for each specimen retrieved. The number of molecular tests ordered or performed on the archived material does not factor in. An addendum to the original report describing the service provided and the results of the molecular studies is one way to report the service, or a separate report is acceptable.
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Inra service for CPT code 88363
A 56-year-old male had a colectomy two years ago for a colonic adenocarcinoma. The laboratory processed the surgical specimen and issued a surgical pathology report. The patient now presents with probable liver metastases diagnosed clinically. The patient’s oncologist requests that the pathologist send tissue to a reference laboratory for KRAS gene mutation analysis.
After verifying that the patient has tissue samples in the pathology archives, the pathologist reviews the reports and examines the slides and blocks from the relevant specimens to determine which has the richest and most representative area of non-necrotic tumor for KRAS analysis, such to be sent to an appropriate reference testing laboratory. The service does not include the molecular diagnostic interpretation or microdissection. The pathologist will document the review of the pertinent pathology reports and slides and selection of the appropriate material for submission.
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General information for CPT code 88363
Global
Work RVU/Base Units: 0.37
Non Facility Practice Expense RVU: 0.29
Facility Practice Expense RVU: 0.18
Professional Liability Insurance RVU: 0.02
Non Facility Total RVU: 0.68
Facility Total RVU: 0.57
Medicare Non Facility National Payment: $23.04
Medicare Facility National Payment: $19.32
Medicare Status*: A
Medicare Policy Indicators*: A+
