Pathology/Lab Coding Alert

Beware C. diff and HLA crossmatch bundles, too.

Already hemmed in by CPT® instruction and prior Correct Coding Initiative (CCI) edits, you'll find even fewer times you can report macrodissection tissue prep for molecular diagnostics, based on third quarter changes.

CCI version 17.2, which takes effect July 1, offers 2,367 new edit pairs and deletes 336 bundles, according to an analysis by Frank Cohen, MPA, MBB, principal and senior analyst with The Frank Cohen Group, LLC. Nearly 125 of those new edit pairs involve the following pathology codes:

• 88387 -- Macroscopic examination, dissection, and preparation of tissue for nonmicroscopic analytical studies (e.g., nucleic acid-based molecular studies); each tissue preparation (e.g., a single lymph node)
• +88388 -- ... in conjunction with a touch imprint, intraoperative consultation, or frozen section, each tissue preparation (e.g., a single lymph node) (List separately inaddition to code for primary procedure).

Prepare to Pigeonhole How You Use 88387, +88388

Adding codes 88387 and +88388 to CPT® opened the door to charges for sterile macroscopic tissue dissection prior to molecular diagnostics tests such as polymerase chain reaction (PCR) for sentinel lymph node biopsy, according to Sophia Hauxwell, MT-ASCP, laboratory scientist in the University of Nebraska Medical Center Molecular Diagnostics Laboratory in Omaha -- but not prior to microbiology or flow cytometry. CPT® text notes state that you should not report 88387-+88388 "for tissue preparation for microbiologic cultures or flow cytometric studies."

"That rules out reporting 88387 or +88388 as prep for any microbiology codes or 88182-88189 (Flow cytometry ...)", says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha.

So it came as no surprise when past CCI versions bundled 88387 and +88388 with flow cytometry and some microbiology codes. Now CCI 17.2 closes the gap by bundling virtually the entire microbiology section -- from 87001 (Animal inoculation, small animal; with observation) to 87255 (Virus isolation; including identification by non-immunologic method, other than by cytopathic effect [e.g., virus specific enzymatic activity]) -- with 88387 and +88388.

Use +88388 with intraoperative consults: When your pathologist performs macroscopic tissue exam and dissection for molecular testing preparation as part of an intraoperative consultation, you should use +88388 instead of 88387 in addition to codes for intraoperative consultations 88329-88334 (Pathology consultation during surgery ...), according to a CPT® text note.

To ensure that you use +88388 with consultations, CPT® states, "use 88388 in conjunction with 88329-88334)" and "do not report 88387 in conjunction with ...88329-88334." CCI edits concur and continue to bundle 88387 with 88329-88334, but do not bundle +88388 with the intraoperative consult codes.

Anatomic pathology surprise: Based on the code definition distinctions, coders have understood that you should use 88387 as opposed to +88388 when the pathologist performs special macroscopic exam and tissue preparation for molecular studies during specimen processing that is not part of an intraoperative consultation.

"In other words, you would expect to use 88387 in addition to the appropriate surgical pathology code from the range 88302- 88309 (Level x -- Surgical pathology, gross and microscopic examination ...)," says William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

But CCI 17.2 adds 88387 as a column 2 code for 88302-88309, leaving coders nowhere to turn. "If the 88387 service is truly a component of 88302-88309 when the pathologist performs special tissue prep for molecular studies on a single specimen, then you'll have a hard time finding a situation that warrants reporting 88387," Dettwyler says. Note that CCI does not bundle 88387 and 88300.

Nix prep charge with referred tissue consults: CCI 17.2 also bundles 88387 and +88388 as a column 2 code with codes for referred-material consultations (88321-88325, Consultation ... [and] report on referred [material]). That means you shouldn't bill 88387 or +88388 in addition to any of these consult codes for the same tissue.

Watch cytopathology bundles: You can't report 88387 in addition to any cytopathology codes 88104-88175, according to CCI 17.2. "These edits shouldn't be a problem because you'd expect to use 88387 for tissue specimens " not cytology specimens," Dettwyler says. On the other hand, be prepared to append modifier 59 (Distinct procedural service) to 88387 if the pathologist performs that service and a cytopathology service on two different specimens on the same day.

Restrict HLA Crossmatch With Cell Counts

Two codes describe human leukocyte antigen (HLA) crossmatch using flow cytometry:

• 86825 -- Human leukocyte antigen (HLA) crossmatch, non-cytotoxic (e.g., using flow cytometry); first serum sample or dilution
• +86826 -- ... each additional serum sample or sampledilution (List separately in addition to primary procedure).

Because 86825 and +86826 are comprehensive tests that use flow cytometry methodology, earlier CCI edits restricted reporting the codes with 88184-88189 (Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; ...) or flow cytometry cell count codes 86355 (B cells, total count) or 86359 (T cells; total count).

CCI 17.2 continues the pattern by bundling 86825 and +86826 with 86356 (Mononuclear cell antigen, quantitative [e.g. flow cytometry], not otherwise specified, each antigen), 86357 (Natural killer [NK] cells, total count), 86360 (T cells; absolute CD4 and CD8 count, including ratio), 86361 (... absolute CD4 count), and 86367 (Stem cells [i.e., CD34], total count).

Don't Miss Other Edits for Your Lab

CCI 17.2 bundles 87493 (Clostridium difficile, toxin gene[s], amplified probe technique) with molecular diagnostics codes 83890-83913 (Molecular diagnostics ...). "Code 87493 includes any molecular diagnostics methods used to perform the test," Dettwyler says.

Choose drug screen: Don't report together 80100 (Drug screen, qualitative; multiple drug classes chromatographic method, each procedure) and G0431 (Drug screen, qualitative; multiple drug classes by high complexity test method [e.g., immunoassay, enzyme assay], per patient encounter) for the same test, according to CCI 17.2. Instead, choose the single, most appropriate drug screen code based on insurer rules and laboratory methods.