Pathology/Lab Coding Alert

Hint: Many procedure bundles remain when code numbers change.

CPT 2009 "moved" several codes from one section to another -- but that doesn't mean the National Correct Coding Initiative (CCI) lets you off the hook.

For many existing procedure definitions that have a new code number, CCI 15.0, effective Jan. 1, removes edit pairs with the deleted code and adds pairs with the new code.

When you bill for a bilirubin test, you have to pick a single code based on the lab method and specimen source. That's why CCI continues to bundle total bilirubin and transcutaneous bilirubin -- even though the codes have changed.

Old edit pair: Prior CCI versions listed a mutually exclusive edit pair for 82247 (Bilirubin, total) with 88400 (Bilirubin, total, transcutaneous).

New edit pair: Now that CPT 2009 deletes 88400, CCI 15.0 adds a new mutually exclusive edit pair for 82247 and the 88400 replacement code -- 88720 (Bilirubin, total, transcutaneous). The modifier indicator of "1" indicates that you can override the edit pair if you demonstrate that you performed two separate, medically necessary bilirubin tests.

TB test includes injection: Because CPT 2009 changed the code for diagnostic injections, CCI 15.0 changes the edit pair for intradermal TB tests. As a non-mutually exclusive edit pair, CCI indicates that the injection is a component of the TB skin test.

Deleted edit pair: Prior CCI versions bundled 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) with code 86580 (Skin test; tuberculosis, intradermal).

New edit pair: Now that CPT 2009 deletes 90772, CCI 15.0 adds a new edit pair for 86580 with the 90772 replacement code -- 96372 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular).

Leukocyte transfusion includes infusion: CCI continues to demonstrate that the infusion step is a component of a leukocyte transfusion procedure (86950, Leukocyte transfusion). Because of CPT 2009 changes to infusion codes, CCI 15.0 changes the edit pairs as follows:

Deleted edit pair: Prior CCI versions bundled 90760 (Intravenous infusion, hydration; initial, 31 minutes to 1 hour) and 90765 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour) with 86950.

New edit pair: Now that CPT 2009 deletes infusion codes, CCI 15.0 adds a new edit pair for 86950 with the 90760 replacement code, 96360 (Intravenous infusion, hydration; initial, 31 minutes to 1 hour). You-ll also see a new edit pair for 86950 with 90765 replacement code 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour).

You-ll see at the end of this article why it is significant that all of these new edit pairs have a modifier indicator of "1."

Some deleted codes are just that -- deleted, not moved. That means CCI 15.0 deletes some edit pairs containing deleted codes without adding new edit pairs.

For instance: Category III code 0026T (Lipoprotein, direct measurement, intermediate density lipoproteins [IDL]) [remnant lipoproteins]) expired in 2009. That's why CCI 15.0 eliminates the prior edit pairs that bundled 0026T with the following codes:

-83700 -- Lipoprotein, blood; electrophoretic separation and quantitation

-83701 -- - high resolution fractionation and quantitation of lipoproteins including lipoprotein subclasses when performed (e.g., electrophoresis, ultracentrifugation)

-83704 -- - quantitation of lipoprotein particle numbers and lipoprotein particle subclasses (e.g., by nuclear magnetic resonance spectroscopy)

-80500 -- Clincal pathology consultation; limited, without review of patient's history and medical records

-80502 -- - comprehensive, for a complex diagnostic problem, with review of patient's history and medical records

Why didn't 0026T move to a category I code? The AMA developed category III codes for new and emerging technologies, says Franz Ritucci, MD, DABAM, FAEP, director of the American Academy of Urgent Care Medicine in Orlando, Fla. Because the AMA uses the codes to gather usage data, reporting category IIIs could contribute to creating future category I codes that will pay.

But if a category III code isn't widely used during the five years following its inception, the AMA archives the code "unless it is demonstrated that a temporary code is still needed," according to the introduction to the codes.

Delete these edits, too: CCI 15.0 deletes edit pairs for P3000 (Screening Papanicolaou smear, cervical or vaginal, up to 3 smears, by technician under physician supervision) and P3001 (Screening Papanicolaou smear, cervical or vaginal, up to 3 smears, requiring interpretation by physician) with certain pediatric critical care and newborn care codes.

The deleted bundles for P3000 and P3001 include 99293-99300 (pediatric and neonatal critical care, and low-birth-weight infant intensive care), and 99431-99440 (normal newborn E/M services).

No new bundles with new codes: Although CPT 2009 moves these codes to a new CPT section, CCI 15.0 doesn't add new P3000 and P3001 edit pairs using the new codes.

Understand Modifier Indicators

The CCI edit tables include a column called "Modifier." You-ll see either a "1" or a "0" in this column for most edit pairs.

Modifier indicator "0" means that you cannot override the edit pairs under any circumstances -- you can never report the two codes together.

"1" is different: The modifier indicator "1," means that you can override an edit with a modifier when appropriate, says Maggie M. Mac, CMM, CPC, CMSCS, CCP, ICCE, consulting manager for Pershing, Yoakley, and Associates in Clearwater, Fla.

Here's how: If you can demonstrate that you performed two separate, medically necessary procedures, you can append a modifier such as 59 (Distinct procedural services) to the column 2 code to override the edit pair.

Definition: Use modifier 59 "to identify procedures/services that are not normally reported together, but are appropriate under the circumstances," explains Medicare in an article available at www.cms.hhs.gov/NationalCorrectCodInitEd/. Justifications Medicare gives for appending modifier 59 include the following:

- Different session or patient encounter

- Different procedure or surgery

- Different site or organ system

- Separate incision/excision

- Separate lesion or separate injury.