Pathology/Lab Coding Alert

And look for hemoglobin modifier change -- again.

Make sure you keep your lab in compliance by implementing three key edit pairs included in Correct Coding Initiative (CCI) fourth quarter changes, which went into effect Oct. 1. CCI version 16.3 introduces 19,667 new edit pairs, as well as changes to the modifier indicator for 83 edit pairs, according to Frank D. Cohen, MPA, MBB, senior analyst with MIT Solutions, Inc. But don't worry; you won't have to sort through all those changes. We've done it for you. To keep your lab on the up and up this quarter, here's what you need to know.

Choose One Code for Single Lipid Specimen

CCI 16.3 adds three edit pairs you need to know for your lab. You'll find that, effective Oct.

1, 83704 (Lipoprotein, blood; quantitation of lipoprotein particle numbers and lipoprotein particle subclasses [e.g., by nuclear magnetic resonance spectroscopy]) is a column 1 code bundled with the following three codes in column 2 on the non-mutually exclusive edit table:

• 80061 -- Lipid panel
• 82465 -- Cholesterol, serum or whole blood, total
• 84478 -- Triglycerides

What that means for you: If your lab performs a lipid panel, total cholesterol or triglycerides test on a blood specimen, you can't additionally report 83704 for the same specimen. "The edit pairs make sense for a single specimen, because codes 80061, 82465 and 84478 describe tests that quantify certain lipoproteins," says William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

But what if the lab reports an abnormal result for a lipid panel, total cholesterol, or triglycerides test, and the physician orders a follow-up quantification using 83704? "The lab would perform a follow up test for quantitation of lipoprotein particle number and subclass using a different blood specimen, probably on a different day, so the edit pairs shouldn't be a problem," Dettwyler says.

Caution: Because the nuclear magnetic resonance (NMR) spectroscopy might include quantification of triglycerides and other lipid fractions, some payers might have frequency limitations for 83704 with other lipid tests.

Use modifier: On the outside chance that the lab acquires a separate specimen to perform 83704 on the same day as 80061, 82465, or 84478, you can override the edit pair with modifier 59 (Distinct procedural service).

Modifier Indicator Allows Two Hemoglobins

Your lab might get a request for two medically necessary hemoglobin tests by different methods in a single day, and as of last quarter, you couldn't bill for both, according CCI.

Effective Jan. 1, 2010, CCI bundled 88738 (Hemoglobin [Hgb], quantitative, transcutaneous) with 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]). Whether you can unbundle the edit pairs for distinct specimens by using a modifier has been a changing proposition each quarter this year. Here's the CCI modifier indicator for these edit pairs over the course of 2010:

• CCI 16.0 -- modifier indicator "0" effective Jan. 1, 2010.
• CCI 16.1 -- modifier indicator "1" retroactive to Jan. 1, 2010
• CCI 16.2 -- modifier indicator "0" retroactive to Jan. 1, 2010
• CCI 16.3 -- modifier indicator "1" retroactive to Jan. 1, 2010

A modifier indicator of '0' means that you can't override the edit pair under any circumstances," Dettwyler explains.

Now that CCI 16.3 changes the modifier indicator back to "1," labs should know that they can override the edit pair using modifier 59, when appropriate.

For instance: "The lab might perform a complete blood count (such as 85025) for an infant,and based on a low hemoglobin count, perform a transcutaneous hemoglobin (88738) later in the day," Dettwyler says. "With these edit pairs in place, the lab could bill for both procedures, but would need to override the edit pair by appending modifier 59 to 88738." Good news: Now that CCI 16.3 reinstates the "1" modifier indicator retroactive to Jan. 1, you might be able to seek payment adjustments for any claims filed during the first and third quarters of 2010 for distinct CBC and transcutaneous hemoglobin tests on the same day.