Pathology/Lab Coding Alert

Distinguish telehealth from lab consults, too.

Effective July 1, you have plenty of new edit pairs to stay on top of for your lab, thanks to Correct Coding Initiative (CCI) version 16.2.

Mind-boggling numbers: CCI 16.2 includes "16,843 new edit pairs, bringing the total number of active edit pairs to 653,718," said analyst Frank Cohen, MPA, MBB of The Frank Cohen Group, LLC, in a recent announcement about the CCI changes.

In addition to edit pairs you read about in "Shun Extra Tissue Prep Charge for Micro and Flow" on page 49, your lab will need to focus on a number of "G" code bundles that could impact your pay.

Concede to Drug Screen and 'Method' Bundles

CMS instructs labs to use the following new-for-2010 HCPCS Level II codes for certain drug screen testing for Medicare beneficiaries:

G0430 -- Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure

G0431 -- ... single drug class method (e.g., immunoassay, enzyme assay), each drug class.

Now CMS provides further coding "instruction" in the form of CCI edit pairs that restrict the use of these codes. CCI 16.2 bundles G0430 with chromatography codes 82486-82489 (Chromatography, qualitative ...). Similarly, you have new edit pairs bundling G0431 with 83516-83518 (Immunoassay for analyte other than infectious agent antibody or infectious agent antigen ...).

Ban method double-dipping: "The drug screen G codes describe testing using a specific method, and you shouldn't additionally report a code for the method," says William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

CCI 16.2 also bundles the drug screen G codes with lab consultation codes 80500-80502 (Clinical pathology consultation ...). "These edits indicate that you can't bill Medicare for a pathologist's medical direction and supervision of the clinical lab drug screen as though it were an 80500 or 80502 consultation," Dettwyler says.

Telehealth or Consult -- Choose 1

If you're reporting HCPCS Level II codes for physician telehealth services, CCI 16.2 makes sure you don't report those codes together with a clinical lab consultation.

CCI 16.2 lists 12 new edit pairs that bundle 80500 and 80502 as components of the following:

• Follow-up inpatient telehealth consultation ... (G0406- G0408)
• Initial inpatient telehealth consultation ... (G0425-G0427)

These edit pairs ensure that you select the single code that best describes the service ��" either a clinical pathology consultation requested by another physician, or a consultation that involves communicating with a patient via telehealth.