Pathology/Lab Coding Alert

Expect bundles with most new 2016 codes.

With 57,161 new edit pairs — roughly 10 percent of which involve pathology/laboratory services — you need to stay on top of Correct Coding Initiative (CCI) version 22.0 changes that went into effect Jan. 1.

Check out the following summary of CCI changes to make sure your lab is ready to bill correctly in 2016.

Avoid Component, Similar Tests with 80081

CPT^® 2016 introduces a new obstetrics panel code (80081, Obstetric panel [includes HIV testing] …), and CCI 22.0 bundles it up with all the panel test components and more.

So if your lab performs the new obstetric panel with HIV testing, don’t additionally report any of the required tests listed in the code descriptor (85004, 85007, 85009, 85025, 85027, 86592, 86762, 86850, 86900, 86901, 87340).

Caution: You also shouldn’t list any other codes that describe similar tests for blood counts, blood typing, or testing for hepatitis B, rubella, or Syphilis, such as the following:

• Blood count codes 85008-85049
• 86780 — Antibody; Treponema pallidum
• Other HIV tests such as 87389
• Complete blood count (CBC) codes G0306-G0307

Beware Molecular Pathology Coding Restrictions

Nine new CPT^® 2016 Tier 1 molecular pathology codes earn a host of new edit pairs in CCI 22.0.

The new CCI edits indicate that when you’re reporting one of the new molecular pathology codes, you should not additionally report any other CPT^® code that uses similar methodology, but would represent “double dipping” for a single test procedure. In other words, don’t bill new molecular codes in the range 81162-81314 with any of the following:

• 84311 — Spectrophotometry, analyte not elsewhere specified
• Culture typing codes 87140-87158
• Codes 87470-87801 for infectious agent detection by DNA or RNA probes
• Cytogenetics codes 88271-88291
• In situ hybridization (ISH) codes 88364-88377
• 81228-81229 — Cytogenomic constitutional (genome-wide) microarray analysis …

“If you performed one of the new molecular pathology test, and separately performed one of these other tests on a different specimen for a different purpose, you could override the edit pair using an appropriate modifier such as 59 (Distinct procedural service),” says William Dettwyler, MT AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

There’s more: CCI 22.0 also bundles the following codes with all Tier 1 and Tier 2 molecular pathology codes:

• +88364 — In situ hybridization (e.g., FISH), per specimen; each additional single probe stain procedure (List separately in addition to code for primary procedure)
• +88369 — Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each additional single probe stain procedure (List separately in addition to code for primary procedure)
• +88373 — Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each additional single probe stain procedure (List separately in addition to code for primary procedure)

Let Genomic Codes Stand Alone

CPT^® 2016 added codes in the range 81410-81471 for Genomic Sequencing Procedures and Other Molecular Multianalyte Assays — a section that was new in 2015. Now CCI 22.0 restricts how you should report these services by adding a host of edit pairs.

The restrictions are broad, bundling codes in this section with all Tier 1 molecular pathology codes (except those for human leukocyte antigen [HLA] testing), all Tier 2 molecular pathology codes, and with most codes in the Multianalyte Assays with Algorithmic Analyses (MAAA) section, including several new codes in the range 81500-81595.

Here’s why: Most of the genomic tests use next generation sequencing and are very comprehensive, so Tier 1, Tier 2 or MAAA tests would likely be a subset of a broader genomic test.

One more thing: You should not bill the genomic test codes with the molecular pathology interpretation code G0452 (Molecular pathology procedure; physician interpretation and report). “Reserve G0452 for when your pathologists interpret a Tier 1 or Tier 2 molecular pathology test,” Dettwyler says.

Skip These MAAA Code Pairs

With many new MAAA codes in the range 81490-81595, CMS went to work creating CCI edit pairs to limit what other services you can report with these codes. And the answer is — don’t report most of the new MAAA codes with any non-HLA Tier 1 molecular pathology code, any Tier 2 molecular pathology test, or any of the following:

• 84311 for spectrophotometry
• Cytogenetics codes 88271-88291
• In situ hybridization (ISH) codes 88364-88377
• G0452 for molecular pathology interpretation and report.

Tissue culture: CPT^® 2016 adds two new codes for tests to determine live tumor cell culture response to drugs — 81535 and 81536 (Oncology [gynecologic], live tumor cell culture and chemotherapeutic response by DAPI stain and morphology, predictive algorithm reported as a drug response score …). CCI 22.0 bundles these codes with the following codes that describe some of the technical steps involved in the 81535 and 81536 procedures:

• Tissue culture codes 88230-88239 (Tissue culture for non-neoplastic disorders …)
• Special stain code 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).