Pathology/Lab Coding Alert

Watch for 2 new codes to replace 86586 You just got used to using 86586 for unlisted cell types in an immunodeficiency panel -- now you have to adjust to using 86356 instead. Here's why: CPT 2008 deletes 86586 (Unlisted antigen, each) and adds two codes in its place: - 86356 -- Mononuclear cell antigen, quantitative (e.g., flow cytometry), not otherwise specified, each antigen - 86486 -- Skin test; unlisted antigen, each. "The change is a welcome clarification for coders reporting immunodeficiency panels or skin tests," says Karen Kavanaugh, RHIT, compliance auditor with Labcorp in Oklahoma City. 1. Cut Through Immunodeficiency Panel Confusion Beginning with code changes in CPT 2005 and continuing with the current 86586 deletion, CPT enforces a clear delineation between flow cytometry cancer studies and immunodeficiency coding. Although both types of testing use flow cytometry methodology and may even involve some of the same cell types, CPT assigns distinctly different code sets for the two tests. Do this: You should use only immunology codes 86355-86367 for immune-response cell-count studies that don't normally require a pathologist's interpretation -- even if the method involves flow cytometry, Kavanaugh says. After adding some of these code definitions in 2005 and then reassigning code numbers in past years and again this year, CPT finally arranges all the immunodeficiency test codes in one consecutive grouping: - 86355 -- B cells, total count - 86356 -- Mononuclear cell antigen, quantitative (e.g., flow cytometry), not otherwise specified, each antigen - 86357 -- Natural killer (NK) cells, total count - 86359 -- T cells; total count - 86360 -- T cells; absolute CD4 and CD8 count, including ratio - 86361 -- T cells; absolute CD4 count - 86367 -- Stem cells (i.e., CD34), total count. Don't miss: A new CPT text note following 86580 states, "86586 has been deleted ... For flow cytometry, quantitative, not otherwise specified, use 86356." Example: The lab receives an order for an immune dysfunction panel that includes CD3 (total T cells), CD4 (helper cells), CD8 (suppressor cells), CD4/CD8 ratio, CD3/HLA-DR, CD8/CD38, CD8/CD28, and CD19 (B cells). The lab reports the results, with no morphologic review by the pathologist and no interpretive report. Solution: Report the service this way: 86359 for T cell total count (CD3); 86360 for CD4 and CD8 absolute counts and ratio; 86355 for B cell total count; and three units of 86356 -- one for each marker: HLA-DR, CD38 and CD28. 2. Use Multiple Codes to Make the Most of Flow Cytometry Reserve the flow cytometry codes (88184-88189) for immunophenotyping of hematolymphoid cancers. Pathologists often use these studies as an adjunct test for surgical pathology specimens. The flow cytometry testing involves panels of "markers" that require interpretation by [...]