Pathology/Lab Coding Alert

Choose just one code for most complete procedure.

The last quarterly Correct Coding Initiative (CCI) update of 2014 may not have many edit pairs for labs, but with instructions that you should never override these bundles, you can’t afford to miss the latest list.

You’ll face just eight new edit pairs for your lab under CCI version 20.3, which went into effect Oct. 1. That’s a sigh of relief for labs, because the overall update boasts 5,247 new edit pairs, bringing the total to number of active edits to 1,340,210, according to Frank Cohen, MPA, MBB, principal and senior analyst for The Frank Cohen Group in Clearwater, Fla. in his analysis of the update.

Sperm Isolation Includes Analysis

If your lab participates in testing and preparing specimens for assisted reproductive technology (ART), you need to pay close attention to the latest round of CCI edits, which create new bundles involving the following two column 1 codes:

• 89260 — Sperm isolation; simple prep (e.g., sperm wash and swim-up) for insemination or diagnosis with semen analysis
  
• 89261 — ... complex prep (e.g., Percoll gradient, albumin gradient) for insemination or diagnosis with semen analysis.
  

Problem: Some coders erroneously mistook “with semen analysis” to mean that you should report these codes in addition to a code for semen analysis. But the phrase actually means that the codes include semen analysis.

Clarification: A CPT® Assistant article published when these codes were new clarified that they “include semen analysis, which is a complex clinical laboratory improvement act analysis,” in contrast to the code that 89260-89261 replaced (October 1998).

Check Out Edit Pairs and Restrictions

Under CCI 20.3, you’ll find the following codes bundled as column 2 codes with both of the sperm isolation codes:

• 89300 — Semen analysis; presence and/or motility of sperm including Huhner test (post coital)
  
• 89310 — ... motility and count (not including Huhner test)
  
• 89320 — ... volume, count, motility, and differential
  
• G0027 — ... presence and/or motility of sperm excluding Huhner.
  

“Each of these edit pairs shows a modifier indicator of “0,” which means that you can’t unbundle the codes under any circumstances,” says Melanie Witt, RN, CPC, COBGC, MA, an independent coding consultant in Guadalupita, N.M.

Understand ART Procedures

A clinician treating a couple for infertility may generate multiple laboratory encounters over months of treatment. ART requires several sequential steps over a period of time, which begins with testing to identify the possible causes of infertility, and proceeds through various lab services to manipulate eggs, sperm, and embryos to facilitate reproduction.

The CCI 20.3 edit pairs involve the steps to analyze semen as it relates to fertility, and later, to prepare the sperm for insemination.

For instance: The clinician may commonly order the following tests to evaluate semen for the listed purpose:

• 89300 — To evaluate cervical mucus receptivity to sperm
• 89310 — To count sperm for fertility evaluation or sterilization reversal
• 89320 — To fully evaluate semen for infertility workup
• 89321 (... sperm presence and motility of sperm, if performed) or G0027 — To qualitatively evaluate semen post-vasectomy (no count).

On the other hand, codes 89260 and 89261 describe the service to actually prepare the sperm for insemination, or less frequently, for a more extensive diagnostic workup. 

For codes 89260-89261, the lab analyst first performs a semen analysis to evaluate factors such as motility, concentration, and cellular components. Then, based on the findings, the lab analyst isolates sperm by simple preparation such as centrifugation and washing (89260), or complex preparation such as swim up or Percoll gradient and centrifugation (89261). 

Key: Because 89260 and 89261 include semen analysis, you can’t separately bill the codes with semen analysis codes such as 89300-89320 and G0027 — thus the new CCI edit pairs restricting those code pairs.