Pathology/Lab Coding Alert

Look for ISH bundling limits, too.

Think you're ready to use all those brand new CPT lab codes? Not so fast. You better learn Correct Coding Initiative (CCI) restrictions first, before you start billing Medicare for services using new 2011 codes.

CMS released CCI version 17.0, effective Jan. 1, revealing 19,822 new active pairs and 9,778 code pair deletions, according to Frank D. Cohen, MPA, MBB, senior analyst with Frank Cohen Group, LLC.

Many of the new code pair additions take aim at CPT codes that debut on Jan. 1, with CCI getting ready to halt payment if you report certain procedures together. Let our experts walk you through the edits that could make billing for some code pairings difficult for your lab.

Influenza Typing and HIV Integrase Stand Alone

CCI 17.0 creates a large number of new edit pairs involving the following new CPT 2011 codes:

• 87501 -- Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, reverse transcription and amplified probe technique, each type or subtype
• 87502 -- ... influenza virus, for multiple types or sub-types, reverse transcription and amplified probe technique, first 2 types or sub-types
• 87906 -- Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, other region (e.g., integrase, fusion).

CCI 17.0 bundles these three as column 1 codes with each molecular diagnostics code in the range 83890-83913 (Molecular diagnostics; ...).

"The edit pairs effectively tell you that these three new specific infectious agent nucleic acid codes include whatever molecular diagnostics techniques your lab uses such as extraction, amplification, and nucleic acid probes," says William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Caution: The edit pairs shouldn't be a problem for your lab -- unless you run separate molecular diagnostics testing on the same date as one of the new codes. If you can document distinct molecular diagnostics testing on the same date for the same patient, you'll have to override the new edit pairs by appending modifier 59 (Distinct procedural service) to the molecular diagnostics codes.

Distinguish Urine vs. Other ISH

You'll have a host of CCI bundling pitfalls to avoid when it comes to reporting the following two new codes for bladder cancer in situ hybridization (ISH):

• 88120 -- Cytopathology, in situ hybridization (e.g., FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; manual
• 88121 -- ... using computer assisted technology. First of all, you can't report these codes with each other or with any of the following ISH codes:
• 88358 -- Morphometric analysis; tumor (e.g., DNA ploidy)
• 88365 -- In situ hybridization (e.g., FISH), each probe
• 88367 -- Morphometric analysis, in situ hybridization (quantitative or semiquantitative) each probe; using computer assisted technology
• 88368 -- ... manual.

"You shouldn't report 88120-88121 together or with any of these other codes because you should choose the one ISH code that most closely describes your lab method and specimen type," Dettwyler says.

Beware consultation bundles: CCI 17.0 prohibits reporting 80500-80502 (Clinical pathology consultation; ...) in addition to 88120-88121. Nor should you list these codes in addition to outside consult codes 88321-88325 (Consultation and report on referred ... [material]).

CCI 17.0 also bundles molecular cytogenetics (88271-88275, Molecular cytogenetics; ...) and molecular diagnostics array codes (88384-88386, Array-based evaluation of multiple molecular probes; ...) with the new urine ISH codes.

Avoid Consults with 88363

CPT 2011 provides a new code for retrieving and selecting archived material for molecular testing -- 88363 (Examination and selection of retrieved archival [i.e., previously diagnosed] tissue[s] for molecular analysis [e.g., KRAS mutational analysis]).

CCI 17.0 bundles 88363 with outside consult codes 88321-88325.

"In other words, retrieving and selecting archived material for additional testing includes any consultation with the ordering physician or the lab that might do the subsequent molecular testing," Dettwyler says.

Watch microdissection edits: CCI also bundles 88363 with codes for microdissection (88380-88381, Microdissection [i.e., sample preparation of microscopically identified target]; ...).