Pathology/Lab Coding Alert

Plus: Limit 86000 blood processing codes with HCPCS Level II 'P' codes.

Already restricted by CPT® instruction and prior Correct Coding Initiative (CCI) edits, you'll find even more limitations for reporting amplified-probe Clostridium difficile testing, thanks to new edit pairs in the third quarter CCI update.

CCI version 17.3, effective Oct. 1, offers 1,380 new edit pairs and 835 terminated bundles, according to an analysis by Frank Cohen, MPA, MBB, principal and senior analyst with The Frank Cohen Group, LLC. Let us help you peer through the numbers to learn the CCI changes that will impact your laboratory.

'Complete' Amplified Probe Code Stands Alone

Earlier CCI versions bundled 87493 (Clostridium difficile, toxin gene[s], amplified probe technique) with several molecular diagnostics codes in the range 83890-83913 (Molecular diagnostics ...).

Now CCI 17.3 also lists 87493 as the column one code with the following six codes in that range:

• 83891 -- Molecular diagnostics; isolation or extraction of highly purified nucleic acid, each nucleic acid type (i.e., DNA or RNA)
• 83898 -- ... amplification, target, each nucleic acid sequence
• +83901 -- ... amplification, target, multiplex, each additional nucleic acid sequence beyond 2 (List separately in addition to code for primary procedure)
• 83902 -- ... reverse transcription
• 83909 -- ... separation and identification by high resolution technique (eg, capillary electrophoresis), each nucleic acid preparation
• 83912 -- ... interpretation and report.

That's because 87493 is an infectious-agent specific code that represents a complete procedure.

"Code 87493 includes any molecular diagnostics methods used to perform the test," says William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Either/or: CCI 17.3 also bundles 87493 with 87324 (Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Clostridium difficile toxin[s]) as mutually exclusive procedures.

"You should choose the single C. diff code that best describes the lab methods used to identify the organism," Dettwyler says.

Don't Double Dip Blood Processing Services

When you bill for a unit of blood or blood product using a HCPCS Level II "P" code, you shouldn't additionally code work that went into preparing the unit. CCI 17.3 adds over 30 edit pairs to help you make that distinction.

For instance: If you're billing for fresh frozen plasma using one of the following codes, you shouldn't additionally report 86927 (Fresh frozen plasma, thawing, each unit), according to CCI 17.3:

• P9017 -- Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit
• P9023 -- Plasma, pooled multiple donor, solvent/detergent treated, frozen, each unit
• P9059 -- Fresh frozen plasma between 8-24 hours of collection, each unit
• P9060 -- Fresh frozen plasma, donor retested, each unit.

The latest CCI edits also bundle the following blood processing codes with multiple blood-product "P" codes:

• 86930 -- Frozen blood, each unit; freezing (includes preparation)
• 86931 -- ... thawing
• 86945 -- Irradiation of blood product, each unit.

For more on CCI edits and to find which ones impact your lab, visit the CMS Web site at www.cms.gov/nationalcorrectcodinited/ncciep/list.asp.