Pathology/Lab Coding Alert

Correct Coding Initiative (CCI) version 8.3 makes it official: You can't report a separate needle placement code for aspiration and needle biopsy services (FNA and bone marrow) or blood collection. Nor can you report a specific organism or molecular code with a comparable generic code.

"These are not new ideas, but you have to know which codes are flagged in CCI 8.3 to avoid unexpected denials when your lab legitimately performs some of these services together," says Laurie Castillo, MA, CPC, CPC-H, CCS-P, a member of the national advisory board of the American Academy of Professional Coders (AAPC) and president of Physician Coding and Compliance Consulting in Virginia. Although many of the 100-plus pathology and laboratory edit pairs added to CCI Edits represent services that you already know are bundled, you need to know how to override the edits when a physician performs separate, medically necessary services for the same patient on the same day.

Needle Placement Doesn't Stand Alone

CCI 8.3 pairs a host of needle-placement codes with both FNA codes (10021, Fine needle aspiration; without imaging guidance; and 10022, with imaging guidance) and bone-marrow codes (38220, Bone marrow aspiration; and 38221, Bone marrow biopsy, needle or trocar). The bundled needle-placement services are as follows:

Similarly, you cannot report autologous blood collection codes (86890, Autologous blood or component, collection processing and storage; predeposited; and 86891, intra-or post-operative salvage) with some of the aforementioned needle-placement codes. Specifically, CCI 8.3 bundles autologous blood collection with 36000, 36410 and 90780.

Most coders know that you would not "unbundle" and separately report the needle-placement portion of an FNA, bone-marrow or autologous blood collection service. "Although clinical situations that require reporting these codes together are uncommon, you have to know how to override the edits if it is medically necessary to perform two of these procedures together for the same patient on the same day," says William Dettwyler, MT-AMT, coding analyst for Health Systems Concepts, a laboratory coding and compliance consulting firm in Longwood, Fla.

For example, if the physician or radiologist introduces a needle into the patient's vein for some other therapeutic or diagnostic purpose (e.g., 36000 or 36410) the same day that the pathologist performs an FNA (e.g., 10021) or bone marrow aspiration (38220), Medicare may deny the pathologist's service. "You would have to report the FNA or bone-marrow aspiration with modifier -59 (Distinct procedural service) to ensure payment for the service," Dettwyler says.

Don't Report Different HER-2/neu Measures Together

Elevated levels of the HER-2/neu gene or its protein product are an important marker for breast cancer prognosis. CCI 8.3 pairs the new code for the HER-2/neu protein serum test (83950, Oncoprotein, HER-2/neu) with other codes that might be used for HER-2/neu assessment.

You cannot report the codes for HER-2/neu gene amplification testing with the serum protein test under any circumstances because CCI 8.3 lists these code pairs with a "0" modifier (see box at left, "Override CCI Edits Cautiously"). The edits pair the serum protein test (83950) with DNA hybridization code 88271 (Molecular cytoge-netics; DNA probe, each [e.g. FISH]) and the hybridization analysis codes 88274 and 88275 (Molecular cytogenetics; interphase in situ hybridization, analyze 25-99 cells; or 100-300 cells). Labs commonly perform tests described by 88271 and 88274 to determine the amplification or increase of HER-2/neu genes in the breast cancer tissue. "Although the serum oncoprotein test (83950) measures the protein overproduction rather than the gene overexpression, the two tests provide similar diagnostic information for breast cancer treatment," Castillo says.

CCI 8.3 also pairs 83950 with codes for each step of molecular diagnostics procedures such as extracting genetic material, isolating and manipulating specific nucleic acid sequences, and interpreting the results (83890-83902, 83912, Molecular diagnostics ). "People have misunderstood the molecular diagnostics codes and tried to report these codes to describe each step of comprehensive procedures such as some infectious agent detection or cytogenetics tests," Dettwyler explains. CCI 8.3 apparently avoids similar coding errors by pairing 83950 with these codes.

Don't List the 'Multiple Organisms'

CCI 8.3 bundles specific "infectious agent detection by nucleic acid probe" codes (87470-87798, excluding quantification codes) with two codes for multiple organism identification: 87800 (Infectious agent detection by nucleic acid [DNA or RNA], multiple organisms; direct probe[s] technique) and 87801 ( amplified probe[s] technique).

"Use 87800 and 87801 when a single probe identifies multiple organisms," Dettwyler says. "The CCI edits clarify that you should not also report the individual organism code for this service." For example, a physician may order the combined DNA probe for Chlamydia and gonorrhoeae, which you should report as 87800. Do not also report the individual organism codes (87490, Infectious agent detection by nucleic acid [DNA or RNA]; Chlamydia trachomatis, direct probe technique; and 87590, Neisseria gonorrhoeae, direct probe technique).

"However, if the physician also orders a completely different infectious agent nucleic acid probe on the same day in addition to the 87800, such as 87475 ( Borrelia burgdorferi, direct probe technique) for a patient with symptoms of Lyme disease, then you'll have to report the codes with modifier -59 to override the CCI edit," Dettwyler says.