Pathology/Lab Coding Alert

Correct Coding Initiative (CCI) edits, version 8.2 that took effect July 1, 2002, will remain active until Sept. 30, 2002. "After extensive revision in the April 2002 CCI Edits , pathology Coder get a reprieve this quarter because only a few changes impact their specialty," 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.

CCI Identifies Inappropriate Coding

"CCI edit pairs represent services that are bundled (components of a more comprehensive service) or would not ordinarily be performed together for the same patient on the same day (mutually exclusive services)," Castillo says. Medicare will not reimburse both services when they are reported together.

However, if the two services of a code pair are carried out as distinct and independent services that are medically necessary, Medicare may reimburse with the appropriate modifier. To indicate that codes represent separate services as opposed to unbundling of a single service, append modifier -59 (Distinct procedural service) to override the edit. For clinical lab tests conducted more than once a day, use modifier -91 (Repeat clinical diagnostic laboratory test).

Every code pair is assigned a "modifier indicator" of either "1," which means a modifier can be used with the pair, or "0," which means a modifier cannot be used. Practices should ensure that they do not indiscriminately override CCI edit pairs, and that when they do, appropriate documentation exists in the medical record to justify the claim of distinct procedural service.

CCI 8.2 Mirrors CPT 2002 Additions/Deletions

Version 8.2 pathology edit-pair additions involve two new codes in CPT 2002. Current glucose test codes (82945, 82947, 82948, 82950, 82951, 82952, 82953 and 82962) cannot be reported with the new continuous glucose monitoring service 95250 (Glucose monitoring for up to 72 hours by continuous recording and storage of glucose values from interstitial tissue fluid via a subcutaneous sensor [includes hook-up, calibration, patient initiation and training, recording, disconnection, downloading with printout of data]). Except for 82945 (Glucose, body fluid, other than blood), a "0" modifier indicator for each of the glucose tests means that a modifier will not override the edit pair when any of the codes are reported with 95250.

Similarly, don't report new code 83950 (Oncoprotein, HER-2/neu) with 86294 (Immunoassay for tumor antigen, qualitative or semiquantitative [e.g., bladder tumor antigen]) or 86316 (Immunoassay for tumor antigen; other antigen, quantitative [e.g., CA 50, 72-4, 549], each). "Coders should never list a specific code like 83950 with a code that describes the same service in more general terms, like 86316," Castillo says. But if a lab actually carried out an 83950 service and an 86316 for a different tumor antigen (such as CA 549) on the same day, coders could legitimately report both services and use modifier -59 to override the edit.

CCI 8.2 eliminates remaining edit pairs involving CPT codes deleted in 2002. The following deleted codes and their bundles are no longer part of the CCI edits:
 

80072 (Arthritis panel) had been bundled with its component tests, but the edit pairs were removed in CCI version 8.2 because the code was deleted in 2002.

85095 (Bone marrow, aspiration only) and 85102 (Bone marrow biopsy, needle or trocar) were replaced by 38220 (Bone marrow aspiration) and 38221 (Bone marrow biopsy, needle or trocar) in CPT 2002. Edit pairs using the new codes were added in past CCI versions, and remaining edit pairs with 85095 and 85102 were deleted in version 8.2.
 

88170 (Fine needle aspiration; superficial tissue [e.g., thyroid, breast, prostate]) and 88171 ( deep tissue under radiologic guidance) were replaced by 10021 (Fine needle aspiration; without imaging guidance) and 10022 ( with imaging guidance) in CPT 2002. Edit pairs using the new codes were added in past CCI versions, and remaining edit pairs with 88170 and 88171 were deleted in version 8.2.