Part B Insider (Multispecialty) Coding Alert

Stop using general codes for analyte specific tests.

You have 15 new codes scattered throughout the pathology/laboratory CPT chapter, so how will you find what you need to know? We'll help you jump start your 2010 claims with this how-to inventory.

"From chemistry to surgical pathology, you'll find new codes in CPT 2010 that you need to know," says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha.

Read through our section-bysection account to discover which tests have new codes that you need to know.

Chemistry changes: CPT 2010 has three new chemistry codes:

• 83987 -- pH; exhaled breath condensate

• 84145 -- Procalcitonin (PCT)

• 84431 -- Thromboxane metabolite(s), including thromboxane if performed, urine.

In addition to the new pH code (83987), CPT 2010 revises pH code 83986 to change "except blood" to "not otherwise specified." "The change clarifies what has been proper coding all along -- that you should not use 83986 for urine pH, because existing urinalysis codes 81000-81003 describe that test, says William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Focus on immunology: Three new immunology codes give your lab more specific means to report certain tests, as follows:

• Ovarian cancer marker: 86305 -- Human epididymis protein 4 (HE4)

• Transplant management immune function marker: 86352 -- Cellular function assay involving stimulation (eg, mitogen or antigen) and detection of biomarker (e.g., ATP)

• Syphilis diagnosis: 86780 -- Antibody; Treponema pallidum. "These codes allow more specificity in reporting. For instance, you can use 86305 for HE4 starting January 1 rather than using generic code 86316 (Immunoassay for tumor antigen, other antigen, quantitative [e.g., CA 50, 72-4,549), each) for the test," Dettwyler says.

Don't miss tissue typing crossmatch:

Two new codes for human leukocyte antigen (HLA) crossmatch represent tests that could help reduce the occurrence of transplant rejection. The following codes describe newer tests:

• 86825 -- Human leukocyte antigen (HLA) crossmatch, noncytotoxic (eg, using flow cytometry); first serum sample or dilution

• 86826 -- Human leukocyte antigen (HLA) crossmatch, noncytotoxic (eg, using flow cytometry); each additional serum sample or sample dilution (List separately in addition to primary procedure).

"Report 86825 for the first serum sample or dilution, and add 86826 each time the lab tests another serum sample or performs an additional dilution to quantify the strength of the antigen/antibody reaction," Dettwyler says.

Grab this surgical pathology opportunity: Labs have been prepping tissue for ancillary studies, such as molecular diagnostics, for as long as the tests have been around. But you have never had a code to capture your lab's work -- until now. Two new codes describe this type of tissue preparation:

• 88387 -- Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (e.g., nucleic acidbased molecular studies); each tissue preparation (e.g., a single lymph node)

• 88388 -- ...in conjunction with a touch imprint, intraoperative consultation, or frozen section, each tissue preparation (e.g., a single lymph node) (List separately in addition to code for primary procedure).

"Note that you'll report 88388 in addition to the primary procedure, such as 88161 (Cytopathology, preparation, screening and interpretation), 88329 (Pathology consultation during surgery;), 88331 (...first tissue block, with frozen section[ s], single specimen), or 88333 (...cytologic examination [e.g., touch prep, squash prep], initial site)," Dettwyler explains.