Pathology/Lab Coding Alert

See why reporting new bundles together was already noncompliant.

Following an April Correct Coding Initiative (CCI) update with no changes for labs, the third quarter brings you significant new restrictions when billing certain influenza, in situ hybridization (ISH), and drug tests.

CMS released CCI version 18.2 , effective July. 1, revealing 2,521 new active pairs and only 88 code pair deletions, according to Frank D. Cohen, MPA, MBB, senior analyst with Frank Cohen Group, LLC. Version 18.2 also changed the modifier indicator for 532 existing code pairs. "Unfortunately, 531 went from an indicator of '1' (you can use a modifier) to a '0' (you can't use a modifier)," Cohen states in his analysis of the changes.

Focus on lab: Make sure you're aware of new lab-code CCI edit pairs and modifier indicator changes to ensure you're filing compliant, payable claims.

Beware Numerous New 87501-87502 Bundles

When CPT® added the following analyte-specific molecular detection codes for influenza virus types and subtypes, CMS wasted no time bundling them with molecular diagnostics codes 83890-83913 (Molecular diagnostics; ...):

• 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, multiplex reverse transcription and amplified probe technique, first 2 types or sub-types.

Choose one: Now, a year and a half later, CCI 18.2 bundles 87501 and 87502 together, which means that you can report only one code for a given test, depending on whether the lab identifies a single influenza type or subtype (87501) or two types or subtypes (87502).

If the lab identifies more than two types/subtypes, you'll need to use add-on code +87503 (... influenza virus, for multiple types or sub-types, multiplex reverse transcription and amplified probe technique, each additional influenza virus type or sub-type beyond 2 [List separately in addition to code for primary procedure]) in addition to 87502.

Watch source: CCI 18.2 also bundles the following codes with 87501-87502, further restricting how you can report lab tests:

• 87150 -- Culture, typing; identification by nucleic acid (DNA or RNA) probe, amplified probe technique, per culture or isolate, each organism probed
• 87153 -- ... identification by nucleic acid sequencing method, each isolate (e.g., sequencing of the 16S rRNA gene)
• 87253 -- Virus isolation; tissue culture, additional studies or definitive identification (e.g., hemabsorption, neutralization, immunofluoresence stain), each isolate.

CPT® range-specific instructions that apply to 87501-87502 state, "these codes are intended for primary source only." That means you should reserve 87150, 87153, and 87253 for culture specimens, and 87501-87502 for primary source specimens.

In other words: The new CCI edits reinforce proper use of these codes rather than establishing new restrictions. You should not list both culture typing and direct-source typing codes for a single specimen.

"If the lab performs influenza typing on two different specimen sources, you can report the bundled codes together using modifier 59 (Distinct procedural service) to override the edit pairs, but only if it is for a valid, distinct procedure," says William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Observe method: You should always select the CPT® code that matches your lab method for a specific test. CCI 18.2 bundles the following codes with 87501-87502 to ensure that you select and report just the single code that most closely describes your influenza test:

• 87275 -- Infectious agent antigen detection by immunofluorescent technique; influenza B virus
• 87276 -- ... influenza A virus
• 87400 -- Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Influenza, A or B, each
• 87804 -- Infectious agent antigen detection by immunoassay with direct optical observation; Influenza.

Heed consultation: As with myriad lab codes that CCI already bundles with clinical pathology consultations, CCI adds edit pairs for 87501-87502 with 80500-80502 (Clinical pathology consultation; ...). These edit pairs remind coders not to separately bill a routine lab test interpretation as a distinct consultation.

Select Most Specific Source or Assay Code

CPT® often provides codes that are specific for specimen-source or analyte but use similar methodologies. CCI 18.2 adds a host of edit pairs to ensure that you report only the most specific code for any given test.

FISH: You'll find new column 1/column 2 bundles for fluorescence in situ hybridization (FISH), as follows:

• 88120 (Cytopathology, in situ hybridization [e.g., FISH], urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; manual) with 88368 (Morphometric analysis, in situ hybridization (quantitative or semi-quantitative) each probe; manual)
• 88121 (... using computer-assisted technology) with 88367 (... using computer-assisted technology).

The edit pairs confirm the CPT® text note following 88368 that states, "For morphometric in situ hybridization evaluation of urinary tract cytologic specimens, see 88120, 88121."

"In other words, reporting the codes in these edit pairs together for a single test was already non-compliant," Dettwyler says.

Examine modifier indicator: Although prior CCI versions already bundled 88120 and 88121, CCI 18.2 changes the modifier indicator from "1" to "0," meaning that you cannot override the edit pair under any circumstances.

Distinguish source: CCI 18.2 bundles the following codes based on specimen source:

• 88240 (Cryopreservation, freezing and storage of cells, each cell line) with 0058T (Cryopreservation; reproductive tissue, ovarian) and 0059T (... oocyte[s])
• 83861 (Microfluidic analysis utilizing an integrated collection and analysis device, tear osmolarity) with 83930 (Osmolality; blood) and 83935 (... urine).

Again, these edit pairs corroborate correct coding based on CPT® instruction, such as the text note following 83935 -- For tear osmolarity using microfluidic analysis, use 83861.

Restrict lupus test: Labs may perform 85598 (Phospholipid neutralization; hexagonal phospholipid) with 85730 (Thromboplastin time, partial [PTT]; plasma or whole blood) to test for the lupus anticoagulant antibody used to identify a specific hemorrhagic disorder. Lab shouldn't perform 85730-85732 (Thromboplastin time, partial [PTT]; ...) in addition to 85598 based on standards of medical practice, according to CCI 18.2.