Can I assume that you are talking about regional lymph node dissections for either breast or colon CA?  In any event, the only lymph nodes that we survey for cytokeratin positive tumor cells are sentinel lymph nodes in women with breast CA where the H&E-stained slides do not show any metastatic tumor cells.  It is not uncommon for us to stain one section from 1-5 different paraffin tissue blocks.  In those cases we do charge an "88342" for each separate block because our surgeons separately label each lymph node.  It is my understanding (and I may be wrong) that there is no scientific validity for performing cytokeratin stains to detect micrometastases in regional lymph node dissections and, therefore, patients and/or insurance companies should not be charged for this testing.  Does anyone else have information on this subject that they can share with us?

R. Cartun

p.s  It sounds like your pathologists/residents/PAs are putting one lymph node in each block in order to get 15-20 blocks on a case? 

>>> Laurie Colbert  09/07/01 07:01PM >>>
What do other facilities do about the IHC billing for micromets cases?
If we can only bill one antibody (such as a keratin) per specimen, and
we are staining15-20 blocks, we are losing a lot of money!!!!!  I'm
curious to see how others handle this.  Thanks!

Laurie Colbert
Huntington Memorial Hospital
Pasadena, CA