Pathology/Lab Coding Alert

You'll need to be on your toes when you're reporting certain CPT 2010 codes for analytes such as procalcitonin with lab method codes for unspecified components.

That's because the Correct Coding Initiative (CCI) recently released version 16.1, revealing 2,054 new active pairs and 1,947 modifier changes, according to Frank D.Cohen, MPA, MBB, senior analyst with MIT Solutions, Inc., in an announcement concerning the changes that are effective April 1. Some of those many changes affect your 2010 pathology codes.

Dealing with these new code pairs and modifier changes will require you to brush off your modifier skills to make sure your lab doesn't lose legitimate pay when performing separate tests for the same patient on the same day.

CCI 16.1 added four mutually exclusive edit pairs to restrict how you report carboxyhemoglobin and methemoglobin.

If you test the constituents using transcutaneous methods, report 88740 (Hemoglobin, quantitative, transcutaneous, per day; carboxyhemoglobin) or 88741( methemoglobin).

CCI 16.1 bundles 88740 with 82375-82376 (Carboxyhemoglobin; quantitative or qualitative), and 88741 with 83045-83050 (Hemoglobin; methemoglobin, qualitative or quantitative).

"These edit pairs ensure that you don't list two codes for a single test. You should select one code based on whether the test is transcutaneous, or a quantitative or qualitative lab test," says William Dettwyler,MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Although CCI lists these bundles with a modifier indicator of "1," meaning that you can override the edit pair when the lab performs separate, medically necessary tests, you'll rarely see that situation. "Because you report the transcutaneous codes 'per day,' an additional lab test for the same constituent would likely be redundant," Dettwyler says.

You've been reporting analyte-specific codes for disease markers des-gamma-carboxy-prothrombin (DCP) and myeloperoxidase (MPO) since CPT 2009 added 83951 (Oncoprotein; des-gamma-carboxy-prothrombin) and 83876 (Myeloperoxidase [MPO]). But now CCI 16.1 adds new edit pairs for these codes that you need to know about.

Know MPO bundles: When the lab tests serum MPO (83876), you shouldn't, according to CCI 16.1, additionally report the lab method using one of the following codes:

• 83520 -- Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified
• 84311 -- Spectrophotometry, analyte note elsewhere specified
• 88319 -- Determinative histochemistry or cytochemistry to identify enzyme constituents, each.

Recognize DCP method pairs: Similarly, CCI 16.1 bundles DCP code 83951 with the following methodspecific codes:

• 83520 (see above)
• 82491 -- Chromatography, quantitative, column (e.g., gas liquid or HPLC); single analyte not elsewhere specified, single stationary and mobile phase
• 86294 -- Immunoassay for tumor antigen, qualitative or semiquantitative (e.g., bladder tumor antigen)
• 86316 -- other antigen, quantitative (e.g., CA 50, 72-4, 549), each.

These edit pairs won't pose a problem if you're reporting MPO and DCP correctly -- using the single, most specific code for the test. But what if your lab performs 83876 or 83951 plus an unlisted-analyte test described by one of the bundled codes?

"Performing a specific test such as DCP along with a 'not otherwise specified' method code would not be unusual, and that's when you'll need to override the edit pair with a modifier," Dettwyler says.

For instance: If the lab performs DCP and CA 50, list 83951 and 86316-59 (Distinct procedural service).

CPT 2010 migrated category III code 0194T (Procalcitonin [PCT]) to category I code 84145 (Procalcitonin [PCT]). And CCI 16.1 promptly established edit pairs to bundle 84145 with the following codes:

• 83516 -- Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method
• 83518 -- single step method (e.g., reagent strip).

"If labs had missed the category III code, they might have been using 83516 to report a procalcitonin test," Dettwyler says. "Now that you have the specific PCT code, you should not list 84145 together with method code 83516 to describe the single test," he says.

If your lab performs an enzyme activity test for other than viral identification using 87905 (Infectious agent enzymatic activity other than virus [e.g. sialidase activity in vaginal fluid]), you should be aware that CCI 16.1 bundles the code with these two codes:

• 82657 -- Enzyme activity in blood cells, cultured cells, or tissue, not elsewhere specified; nonradioactive substrate, each specimen
• 84275 -- Sialic acid.

If you perform two separate tests, such as 87905 for bacterial vaginosis and a leukocyte lysosomal enzyme test, you should append modifier 59 to 82657 to override the edit pair.

Among the 1,947 modifier changes, one group stands out for lab coders. CCI 16.1 changes the modifier indicator bundling new code 88738(Hemoglobin [Hgb], quantitative, transcutaneous) into 85025 (Blood count; complete [CBC], automated [Hgb, Hct, RBC, WBC and platelet count] and automated differential WBC count) and 85027 ( complete [CBC], automated [Hgb, Hct, RBC, WBC and platelet count]).

CCI previously listed the 88738 edit pairs with modifier indicator "0," meaning that you cannot override the bundles under any circumstances. But effective April 1, the modifier indicator for these code pairs is "1."

Bottom line: "If the physician demonstrates medical necessity for transcutaneous hemoglobin in addition to a lab CBC, you can report both services by appending modifier 59 to 88738," Dettwyler says.