Pathology/Lab Coding Alert

The Correct Coding Initiative (CCI) 8.1 took effect April 1, 2002, and will remain in effect until June 30, 2002. Pathology coders will need to be aware of a host of edit pairs that require a modifier if the services are performed and reported for the same patient on the same day.

"With nearly 600 new edit pairs in CCI version 8.1 , being familiar with the bulk of the changes presented here should help coders properly report bundled or mutually exclusive procedures if they are legitimately performed for the same patient on the same day," says Laurie Castillo, MA, CPC, CPC-H, CCS-P, member of the national advisory board of the American Academy of Professional Coders (AAPC) and president of Physician Coding and Compliance Consulting in Virginia. About 75 pathology code pairs are also deleted.

"Although many of the new edit pairs represent services that would not likely be performed concurrently, coders must be aware of the changes in order to override the edit on the occasion that these services legitimately occur together," says William Dettwyler, MT-AMT, coding analyst for Health Systems Concepts, a laboratory coding and compliance consulting firm in Longwood, Fla. FNA Bundled with Biopsies Most of the deletions and over 150 of the code pair additions involve fine needle aspiration (FNA) codes. Although the two FNA codes, 88170 and 88171, were replaced in CPT 2002 with new codes 10021 (Fine needle aspiration; without imaging guidance) and 10022 ( with imaging guidance), many edit pairs with the old codes remained in the CCI edits until this update. "Approximately 50 edit pairs containing the old FNA codes were deleted in CCI 8.1," Dettwyler says. All of the deleted edit pairs involving 88170 and 88171, such as the pairing of each of these old FNA codes with breast biopsy codes (19100-19103), were replaced with new edit pairs using the new FNA codes (10021-10022). "Additionally, codes 10021 and 10022 were each paired with about 75 codes representing biopsy services that were not previously bundled with FNAs, for a total of about 150 new code pairs," Dettwyler says.

These biopsy codes are found in the various surgery sections of the CPT manual, ranging from 10000-60000-level codes. The code pairs are too numerous to list here, but they essentially encompass biopsy and some excision codes for any anatomic site, whether or not the procedure includes "needle" terminology. For example, the pairings include some needle biopsy codes such as 38505 (Biopsy or excision of lymph node[s]; by needle, superficial [e.g., cervical, inguinal, axillary]) as well as some excision codes such as 21555 (Excision tumor, soft tissue of neck or thorax; subcutaneous).
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