© Copyright 2025 American Medical Association. All rights reserved.
The CPT® Code 88356 refers to a specialized laboratory test known as morphometric analysis of nerve fibers. This procedure is specifically designed for the pathological analysis and quantification of intraepidermal nerve fiber (IENF) density and/or sweat gland nerve fiber (SGNF) density obtained from a skin punch biopsy. The primary objective of this analysis is to assist in the diagnosis of peripheral nerve diseases that affect small nerve fibers. Small fiber neuropathy (SFN) is a condition characterized by sensory pain in the extremities, often presenting with normal results on electromyography and nerve conduction studies, indicating that large fiber neuropathic disease is not present. Various medical conditions are associated with SFN, including diabetes, HIV, systemic lupus erythematosus, and neurosarcoidosis. To perform this test, a skin punch biopsy is typically taken from the lower extremity, with the calf being the preferred site. The collected tissue is then processed using a microtome, which slices the tissue into thin sections. These sections are subjected to immunostaining with anti-protein-gene-product 9.5 antibodies, which helps in visualizing the small sensory fibers. The analysis is conducted using either immunohistochemical or immunofluorescent techniques to examine the morphology of the small sensory fibers that innervate the skin. During the evaluation, the number of intraepidermally originating nerve fibers that cross the basement membrane between the dermis and epidermis is counted across several sections. Additionally, the total length of the epidermis is measured, allowing for a calculation of the number of nerve fibers per millimeter. This calculated density is then compared to normative data to either support or rule out a diagnosis of small fiber neuropathy.
© Copyright 2025 Coding Ahead. All rights reserved.
The morphometric analysis of nerve fibers, as described by CPT® Code 88356, is indicated for the evaluation of conditions that may lead to small fiber neuropathy (SFN). The following conditions are explicitly associated with the need for this procedure:
The procedure for performing morphometric analysis of nerve fibers involves several critical steps to ensure accurate results. First, a skin punch biopsy is obtained from the lower extremity, with the calf being the preferred site for tissue collection. This biopsy provides a sample of skin that contains the nerve fibers necessary for analysis. Once the biopsy is collected, the tissue is processed using a microtome, which slices the sample into thin sections suitable for examination. Next, the sections are subjected to immunostaining with anti-protein-gene-product 9.5 antibodies. This immunostaining is crucial as it highlights the small sensory fibers within the tissue, allowing for better visualization during analysis. The stained tissue is then examined using either immunohistochemical or immunofluorescent techniques. These techniques enable the pathologist to identify the morphology of the small sensory fibers that innervate the skin effectively. During the examination, the pathologist counts the number of intraepidermally originating nerve fibers that cross the basement membrane between the dermis and epidermis in several sections of the biopsy. This counting process is essential for determining the density of nerve fibers. Additionally, the total length of the epidermis is measured to facilitate the calculation of nerve fibers per millimeter. This calculated density is then compared to normative data to support or rule out a diagnosis of small fiber neuropathy.
After the morphometric analysis of nerve fibers is completed, the results are compiled and interpreted by the pathologist. The findings will indicate whether the density of intraepidermal nerve fibers is within normal limits or if there is a significant reduction that may suggest the presence of small fiber neuropathy. The pathologist's report will provide critical information that can guide further clinical management and treatment options for the patient. It is essential for healthcare providers to review the results in conjunction with the patient's clinical history and other diagnostic tests to arrive at a comprehensive diagnosis. No specific post-procedure care is mentioned, but standard practices for handling biopsy sites should be followed to ensure proper healing and minimize complications.
| Short Descr | ANALYSIS NERVE | Medium Descr | MORPHOMETRIC ANALYSIS NERVE | Long Descr | Morphometric analysis; nerve | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 1 - Diagnostic Tests for Radiology Services | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | STV-Packaged Codes | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | T1G - Lab tests - other (Medicare fee schedule) | MUE | 3 | CCS Clinical Classification | 234 - Pathology |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 91 | Repeat clinical diagnostic laboratory test: in the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. note: this modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. this modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). this modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient. | TC | Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | GW | Service not related to the hospice patient's terminal condition | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 90 | Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number. | GC | This service has been performed in part by a resident under the direction of a teaching physician | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2011-01-01 | Changed | Short description changed. |
| Pre-1990 | Added | Code added. |
Get instant expert-level medical coding assistance.