Oncology & Hematology Coding Alert

Question: We're researching CellSearch coding. Does 0280T describe the test plus interpretation and report?

Virginia Subscriber

Answer: Guidelines with 0280T (Cell enumeration using immunologic selection and identification in fluid specimen [e.g., circulating tumor cells in blood]; interpretation and report) instruct you to report this code with 0279T (Cell enumeration using immunologic selection and identification in fluid specimen [e.g., circulating tumor cells in blood]).

Coding experts interpret this to mean that 0279T represents the technical component of performing the test and 0280T represents the professional component.

Palmetto Medicare indicates that 0280T is appropriate only "in the rare instance when the physician actually performs the service and not the laboratory technologist /laboratory scientist" (MolDx: CellSearch Billing/Coding Guidelines Update; May 1, 2012; http://www.palmettogba.com/palmetto/providers.nsf/docsCat/Jurisdiction%201%20Part%20B~Browse%20by%20Topic~MolDx ).

Extras: Be sure to check individual payer policies for specific coding rules. For instance, the Palmetto article instructs its providers to "Enter 'ZBD69' in the comment/narrative field on each claim line if 0279T and 0280T are performed for the following claim field/types: Loop 2400, NTE02, or SV101-7 field for the 5010A1 837P." Or if you use a paper claim, submit ZBD69 on an attachment.

Diagnoses: The test's purpose is to detect circulating tumor cells (CTC) in the blood of patients with metastatic breast cancer, colorectal cancer, or prostate cancer. As a result, you may find payers publish covered ICD-9-CM codes. For instance, J5 WPS Medicare providers will find the following codes listed in local coverage determination L32218 (www.wpsmedicare.com/j5macpartb/policy/active/local/l32218_path033.shtml):

• 153.0-153.9, Malignant neoplasm of colon
• 154.0-154.8, Malignant neoplasm of rectum, rectosigmoid junction, and anus
• 174.0-174.9, Malignant neoplasm of female breast
• 175.0-175.9, Malignant neoplasm of male breast
• 185, Malignant neoplasm of prostate.

Watch for: The CPT® Editorial Panel accepted the conversion of 0279T and 0280T to Category I codes (8615x). The 2013 code changes won't be finalized until the fall, but you can review Panel actions in the files at www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/cpt-summary-panel-actions.page.