Pathology/Lab Coding Alert

Transcutaneous tests bridge lab/ER.

The newest CPT lab category introduces three codes that you can expect to see most often in emergency room use. Make sure you avoid code-confusion and costcenter pitfalls to earn the pay you deserve for these tests.

By introducing the new category In Vivo (e.g., Transcutaneous) Laboratory Procedures in 2009, CPT opens the way for three tests now -- and more in the future.

1. Meet the Family

Although the three new CPT 2009 codes all describe transcutaneous procedures,the new category is broader than that.

By describing the category as in vivo, CPT allows for any type of assay that doesnt require a specimen source -- transcutaneous is just one such method, explains Charles B. Root, PhD, president of CodeMap, a laboratory coding and reimbursement consulting company in Barrington, Ill.

Make sure youre familiar with these three new in vivo codes:

" 88720 -- Bilirubin, total, transcutaneous

" 88740 -- Hemoglobin, quantitative, transcutaneous, per day; carboxyhemoglobin

" 88741 -- & methemoglobin.

Bilirubin moved: Although 88720 is a new code number, the code description isnt new. CPT 2009 deleted 88400 (Bilirubin, total, transcutaneous) and replaced itwith 88720 with the same definition.

The point of deleting 88400 and replacing it with 88720 was to move the code to the new in-vivo category, Root says.

Look for high ER use: Because new codes 88740 and 88741 describe analyte tests used to assess poisoning without the need to draw a blood specimen, you can expect to see physicians order these tests mostly in the emergency room.

Physicians use carboxyhemoglobin to asses carbon monoxide poisoning. If the procedure involves a noninvasive method such as a sensor on the finger, you should report 88740.

Similarly, physicians order methemoglobin to assess conditions that elevate this non-oxygen binding form of hemoglobin, such as poisoning from certain anesthetics.Use 88741 for a transcutaneous sensor that doesnt involve drawing a blood specimen.

2. Distinguish In Vitro Tests

Labs have performed in-vitro tests for carboxyhemoglobin or methemoglobin for years. The new in vivo codes dont change how you should report the standard lab tests.

If the lab tests a blood specimen for either carboxyhemoglobin or methemoglobin, choose the appropriate code from the chemistry section, says Larry Small, MS,MT(ASCP), owner of Colaborate, a laboratory and pathology compliance and billing consulting group in Tampa, Fla.

The possible codes are as follows:

" 82375 -- Carboxyhemoglobin; quantitative

" 82376 -- & qualitative

" 83045 -- Hemoglobin; methemoglobin, qualitative

" 83050 -- & methemoglobin, quantitative.

Change: CPT 2009 revised 82375 and 82376 to accurately identify the test analyte. The old definitions listed carbon monoxide, which describes the purpose of the test. The new definitions list carboxyhemoglobin, which describes the test analyte.

To ensure that you dont confuse the new in vivo tests with existing chemistry tests, CPT 2009 added several text notes to point you in the right direction:

" A note following 88740 reads, For in vitro carboxyhemoglobin measurement, use 82375.Conversely, a note following 82376 instructs, For transcutaneous measurement of carboxyhemoglobin,use 88740.

" Similarly, a note following 88741 states, For in vitro quantitative methemoglobin determination, use 83050, while a note following 83050 reads, For transcutaneous quantitative methemoglobin determination, use 88741.

3. Capture This Cost Center Opportunity

The new in vivo tests like 88740 and 88741 often take place as point-of-care assessments. The emergency room might capture the fee as a monitoring service similar to pulse-oximetry. Or the payment ($7.33 national limit amount paid on the Clinical Laboratory Fee Schedule) might go to the lab cost center if the test involves a one-time measurement similar to an in-vitro lab test.

Some lab associations dont want to take ownership of the transcutaneous carboxyhemoglobin and methemoglobin tests because they cant be sent to the lab,Root observes.

But with new in vivo tests, such as glucose, in the pipeline, labs should ask themselves if they really want to abandon this whole category of tests, Root says. I think labs would be wise to try to keep these tests on their turf.