Pathology/Lab Coding Alert

Update bundles for cytology, special stains.

Just as you're starting to use CPT® 2012 changes in your laboratory, the latest edition of Medicare's Correct Coding Initiative (CCI) restricts how you can use some of those codes.

CCI released version 18.0, effective Jan. 1, revealing 15,530 new active pairs and 6,197 code pair terminations, according to Frank D. Cohen, MPA, MBB, senior analyst with Frank Cohen Group, LLC.

Most of the new code pair additions for laboratory involve CPT® codes that debuted on Jan. 1, with CCI now halting payment if you report certain procedures together.

Remember: You cannot simply add a modifier (such as 59, Distinct procedural service) any time you want to separate a code bundle " you'd have to justify it with the physician's documentation that shows the distinct nature of the service, such as a separate site or session, says Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner of Precision Auditing and Coding.

87389 Stands Alone

With plenty of HIV lab tests available, only one code describes a single-result test for antigens and antibodies. That code was added in CPT® 2012: 87389 (HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result).

In contrast, other HIV CPT® codes describe a test for one or the other -- HIV antibodies or HIV antigens. Other HIV-1 and HIV-2 antigen and antibody test codes are as follows:

Antibody tests:

• 86701 -- Antibody; HIV-1
• 86702 -- ... HIV-2
• 86703 -- ... HIV-1 and HIV-2 single result

Antigen tests:

• 87390 -- Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; HIV-1
• 87391 -- ... HIV-2
• 87534 -- Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, direct probe technique
• 87535 -- ... HIV-1, amplified probe technique
• 87536 -- ... HIV-1, quantification
• 87357 -- ... HIV-2, direct probe technique
• 87358 -- HIV-2, amplified probe technique
• 87359 -- ... HIV-2, quantification.

CMS bundles some of these tests with 87389 in the latest CCI update. Specifically, new edit pairs restrict billing 87389 with the combined HIV-1/HIV-2 antibody test (86703) and HIV-1 antigen tests 87535, 87536 and 87390. The "0" modifier indicator for most of these code bundles means that you should not override the edit pair under any circumstance.

Here's why: Because 87389 indicates both the HIV-1 antigen status and the HIV-1/HIV-2 antibody status of the patient, additionally reporting individual tests for the same indicators would be inappropriate.

That's not all: CCI 18.0 also bundles 87389 with some services that might be part of the prep steps for that assay: 87147 (Culture, typing; immunologic method, other than immunofluoresence [e.g., agglutination grouping], per antiserum) and 87253 (Virus isolation; tissue culture, additional studies or definitive identification [e.g., hemabsorption, neutralization, immunofluoresence stain], each isolate). These bundles have a modifier indicator of "1," meaning that you can override the edit pair, when appropriate.

If the virus isolation or culture typing is not part of 87389, but you perform it for a different test on the same day as the combined HIV test, you can use modifier 59 to override the edit pair.

Adaptable test: Code 87389 represents a method that labs can perform on a variety of platforms, according to Vickie Baselski, PhD, department of pathology, University of Tennessee Health Science Center in Memphis representing the American Society for Microbiology at the CMS public meeting on the new codes. Plus, the test provides a diagnostic opportunity for earlier HIV detection, so understanding the bundling limitations is likely to be important for your lab.

Acknowledge Cytopathology Bundles

CCI has long bundled various cytology procedure codes, but the latest version adds an edit pair with 88104 (Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation) as a column 1 code to 88106 (... simple filter method with interpretation).

Although these codes aren't new, CPT® 2012 adds a new text note that states, "Do not report 88106 in conjunction with 88104."

CMS rule: The new CPT® text note and the new CCI edit pair align with CMS guidelines in the CCI Policy Manual concerning these codes: "For a single specimen, only one code from a group of related codes describing a group of services that could be performed on the specimen with the same end result (e.g., 88104-88112 ...) should be reported." In contrast to this CCI rule, past AMA convention allowed reporting multiple non-gyn cytopathology preparations from a single source, in some circumstances. The new CPT text note and CCI edit brings the question closer to consensus.

Override opportunity: The Policy Manual goes on to state, "If multiple services (i.e., separate specimens from different anatomic sites) are reported, modifier 59 should be utilized to indicate that different levels of service were provided for different specimens from different anatomic sites."

Hit Delete Button

CCI 18.0 terminates many code bundles, but the lab deletions all reflect CPT® codes eliminated in 2012.

That's why you'll find 15 terminated edit pairs with deleted code 88107 (Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears and simple filter preparation with interpretation), and three terminated edit pairs with deleted code 88318 (Determinative histochemistry to identify chemical components [e.g., copper, zinc]).