RIP 88342 – Part 2: Dear Patient, We are sorry to inform you that

we can no longer offer immunohistochemistry services to assist in the diagnosis of your case.  We have been informed by Medicare that this service is, for as long as Medicare exists, not really valued and if there are alternatives to diagnose your case we should use them. In fact, we are going to have to rely upon gross pathology, H&E morphology and do a clinicopathologic correlation to diagnose your case, like we use to do before this test became widely available about 20 years ago.  

Several pathologists are suggesting this approach and have been given notice, that if, you can avoid it, perhaps reconsider doing more immunohistochemical stains than absolutely necessary.  If you can diagnose Helicobacter pylori on H&E, go for it.  If you can’t – consider Giemsa stain.  If this fails you – consider immunohistochemistry as a last resort.

Dr. Mark Wick, a professor at the University of Virginia who knows a thing or two about immunohistochemistry having written extensively on the subject mentioned a post/rant on his blog recently @ http://www.mrwickmd.com/blog.html.

I have excerpted his thoughts on recent death of the 88342 immunohistochemistry code.  

He has the nerve to suggest that we work with our clients, clinical colleagues, administrators, payers and patients to educate them about what we can and can’t do and taking a “back from the future” approach. Had we done this years ago perhaps this wouldn’t have happened.

Courtesy of Mark R. Wick, MD blog:

For now, I suggest the implementation of several steps in response to the above-cited situation:

1.       Efforts should be expended to inform our clinical colleagues (surgeons, internists, pediatricians, gynecologists, etc.), health system administrators, and patients that we will no longer have the wherewithal to perform the breadth and depth of tests to which they have become accustomed in anatomic pathology.  This will doubtlessly cause a cataclysmic backlash from them, but we all must adapt to the “brave ‘new’ world” of medical practice together.

2.       Anatomic pathologists need to pursue a “back from the future” approach  to practice, with renewed emphasis on detailed morphological evaluations and the liberal use of collegial consultations between the members of practice groups.   We should not forget that, if they are documented, the latter steps do meet the medicolegal onus for “due diligence,” and there is no codified mandate to send difficult cases to extramural consultants instead.

3.       Laboratory physicians of today must be more attuned to historical methods of practice in anatomic pathology.  Just because a procedure is dated, that does not mean that it is useless.  Avenues of diagnostic evaluation such as traditional histochemistry and electron microscopy should be resurrected, reevaluated, and refined to meet current needs .

4.       A stronger emphasis must be placed in the future on evidence-based practice, formal evaluations of the efficacy of diagnostic criteria, and assessment of the cost-effectiveness of adjunctive testing in anatomic pathology.  We must not continue to do things that do not really work.