Pathology/Lab Coding Alert

Add hundreds of pairs to your ‘restricted list.’

Each year brings new, revised, and deleted CPT® codes that you have to learn to keep your lab’s pay on the up and up. And hot on the heels of code changes are Medicare’s Correct Coding Initiative (CCI) first quarter changes — many of which involve the CPT® code changes.

CCI 19.0, which took effect on January 1, 2013, adds 37,587 new bundles and deletes 16, 716. Read on to find out which CCI changes might affect your lab and pathology coding. 

Steer Clear of MoPath with FISH, Molecular Cytogenetics 

If your lab bills for any of the Tier 1 (81200-81355) or Tier 2 (81400-81408) molecular pathology codes, you’ll need to make sure you don’t bill the codes with any of the following codes for the same specimen:

• 88271-88275 — Molecular cytogenetics ….
• 88365 — In situ hybridization (e.g., FISH), each probe
• 88367-88368 — Morphometric analysis, in situ hybridization (quantitative or semi-quantitative) each probe ….

CCI 19.0 lists these edit pairs with a “1” modifier indicator. “That means you can bill a molecular pathology test and a molecular cytogenetics or FISH test together for the same patient on the same day if your lab performs separate analyses on distinct specimen sources,” says William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore. 

Pick one variant group: CCI 19.0 also bundles many molecular pathology codes for the same gene, different variants. For example, you can’t report together 81202 (APC [adenomatous polyposis coli] [e.g., familial adenomatosis polyposis (FAP), attenuated FAP] gene analysis; known familial variants) and 81203 (… duplication/deletion variants). 

Most of these CCI “variant bundles” are listed with a “0” modifier indicator. “That means you can’t override the edit pairs under any circumstances,” Dettwyler says.

More Tier 2 bundles: CCI 19.0 also creates many more edit pairs, with each of the Tier 2 codes (81400-81408) listed as column 2 codes with culture typing (87140-87158, Culture, typing …) and codes for infectious agent identification by nucleic acid (87470-87801). 

Pick One HLA Tissue Typing Method 

CCI 19.0 dishes up plenty of new edit pairs for human leukocyte antigen (HLA) tissue typing codes. 

First: More than 75 new edit pairs bar you from reporting any HLA Class I and/or Class II typing by molecular methods (81370-81383) with any other code from the same range — or with any code from the range 86812-86817 (HLA typing …) for Class I or Class II antigens (A, B, C, DR/DQ). In other words, select just one code that accurately describes the method and HLA antigen(s) tested; don’t report multiple HLA tissue typing codes for a single test.

Second: CPT® 2013 adds eight new codes for HLA Class I and/or Class II tissue typing: 86828-86834 (Antibody to human leukocyte antigens [HLA], solid phase assays [e.g., microspheres or beads, ELISA, flow cytometry] …). CCI 19.0 adds 60 new edit pairs to keep you from reporting these codes together (you should pick just one), and to restrict reporting an HLA typing code in addition to codes for the lab method (such as flow cytometry). That means bundling the new codes with method codes 88184-88189 (Flow cytometry …) and 86807-86808 (Serum screening for cytotoxic percent reactive antibody [PRA]…).

Watch modifier: You’ll find modifier indicator “0” for most edit pairs that restrict you to “pick one” code for the HLA tissue typing test, meaning that you can’t unbundle the codes. However, most of the new edit pairs for HLA typing with “method” codes show a modifier indicator of “1,” meaning that you can override the edit pair if you’re performing two tests on separate specimens. 

Don’t Bill Components With MAAAs

You read last month how CPT® and CMS give different instructions for reporting multi-analyte assays with algorithmic analyses (MAAAs) (Pathology/Lab Coding Alert Vol 14 No. 2 “Maneuver CPT® and CMS Instructions’ Split Decision for MAAA Coding”). Now CCI 19.0 weighs in on the issue. 

Background: MAAAs are procedures that use results of various assays to perform an algorithmic analysis and report a “score” or similar numeric indicator for diagnostic or prognostic purposes.

You’ll find nearly 30 new edit pairs for MAAA codes 81500-81512 in CCI 19.0. Each edit pair bundles the MAAA code with a component assay. 

For instance: CCI bundles 81500 (Oncology [ovarian], biochemical assays of two proteins [CA-125 and HE4], utilizing serum, with menopausal status, algorithm reported as a risk score) with 86304 (Immunoassay for tumor antigen, quantitative; CA 125) and 86305 (Human epididymis protein 4 [HE4]).

“It’s interesting that CCI 19.0 creates edit pairs for the MAAA codes in light of the fact that CMS doesn’t not recognize the codes for payment,” Dettwyler observes.

Other Cells Out with CTC

New CPT® 2013 codes for circulating tumor cells (CTC) 86152 (Cell enumeration using immunologic selection and identification in fluid specimen [e.g., circulating tumor cells in blood]) and 86153 (… physician interpretation and report, when required) are the focus of nearly 40 new CCI edit pairs. 

CCI 19.0 bundles 86152 and 86153 . as column 1 codes, with other immunology codes for cell identification as column 2 codes — 86255-86256 (Fluorescent noninfectious agent antibody …) and codes for B cells, NK cells, stem cells, T cells, and unspecified cell antigens (86355-86357). 

The edit list also bundles 86152 and 86153 in column 1 with method codes in column 2, as follows:

88184-88189 — Flow cytometry …

88313 — Special stain including interpretation and report; Group II, all other (e.g., iron, trichrome), except stain for microorganisms, stains for enzyme constituents, or immunocytochemistry and immunohistochemistry

88342 — Immunohistochemistry (including tissue immunoperoxidase), each antibody

88346-88347 — Immunofluorescent study, each antibody …

88358-88361 — Morphometric analysis …

Opportunity: If you perform any of these tests on a separate specimen on the same day as the CTC test, you can override the edit pair by using modifier 59 (Distinct procedural service) on the column 2 code. 

Check Deletions, Too

CCI 19.0 boasts a host of code pair deletions, primarily related to deleted codes. 

You’ll no longer have edit pairs dealing with deleted molecular diagnostics stacking codes (83890-83914) or array codes (88384-88386).

Look ahead: In addition to the many CCI edits discussed here, other recent CCI changes will have a big impact on your lab. Stay tuned to future issues of Pathology/Lab Coding Alert to see how CCI Policy Manual changes and other CCI edits will affect your bottom line.