Pathology/Lab Coding Alert

Update your transfusion medicine guidelines, too.

You always watch to see how Correct Coding Initiative (CCI) quarterly updates impact your lab, but if you overlook changes to the National Correct Coding Initiative Policy Manual, you could miss lots of coding restrictions and unbundling possibilities that impact your bottom line.

Thanks to a Jan. 2012 update, your lab has lots of new rules to face this year. You read about some of those changes in "88342, 88360-88361: Report IHC Per Specimen for Medicare Beneficiaries" in Pathology/Lab Coding Alert Vol. 13 no.2. Now we've got the lowdown on a few more important changes that are sure to affect the way you code your services.

Background: Each year, CMS updates the Policy Manual, which offers rationale for various CCI edits, and also describes acceptable scenarios for overriding some edit pairs.

Leverage Lipoprotein Instructions

CMS says physicians would not normally order 83704 (Lipoprotein, blood; quantitation of lipoprotein particle numbers and lipoprotein particle subclasses [e.g., by nuclear magnetic resonance spectroscopy]) on the same date as any of the following codes:

• 80061 -- Lipid panel
• 82465 -- Cholesterol, serum or whole blood, total
• 84478 -- Triglycerides
• 83718 -- Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol).

That's why you'll find that list bundled into 83704 as column 2 codes.

Limitation: If your lab performs a lipid panel, total cholesterol, triglycerides, or direct HDL test on a blood specimen, you can't additionally report 83704 for the same specimen. "The edit pairs make sense for a single specimen, because codes 80061, 82465, 83718, and 84478 describe tests that quantify certain lipoproteins," says William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore. ››››››››

The Policy Manual goes on to explain that a physician may order an NMR lipoprotein panel as a follow-up study for an abnormal lipid panel, or for "a previously diagnosed lipid panel abnormality and separate NMR lipoprotein panel abnormality that require retesting after a therapeutic intervention." For bundled charges that appear on the same date of service, you may override the edit pair using modifier 59 (Distinct procedural service).

Exception: CCI shows a "0" modifier indicator for the 83704/83718 bundle, so you can't override that edit pair.

Abide By Transfusion Guidelines

If your lab reports HCPCS Level II "P" codes for blood products, CMS has some guidance for you in the latest Policy Manual update.

CMS says: If you're billing a "P" code (such as P9057, Red blood cells, frozen/deglycerolized/washed, leukocytes reduced, irradiated, each unit), don't report a CPT lab code for a process that was used to prepare the blood product.

Follow this guidance:

• P codes for irradiated blood include service 86945 (Irradiation of blood product, each unit)
• P codes for CMV negative blood include service 86644/86645 (Antibody; cytomegalovirus [CMV]...)
• P codes for deglycerolized blood include service codes for freezing/thawing blood unit 86930-86932 (Frozen blood, each unit ...)
• P codes for pooled blood products include service 86965 (Pooling of platelets or other blood products)
• P codes for frozen plasma products include service 86927 (Fresh frozen plasma, thawing, each unit).

If you perform an unrelated lab procedure, such as a CMV antibody test, on the same day that the patient receives a blood product prepared using that method, you can override the edit pair by appending modifier 59 to the column 2 (lab) code.

Tap G0431 for High Complexity

After denying a request to add a "G" code and reconsider current pricing for Medicare drug screens, CMS finalizes its guidelines in the latest Policy Manual update.

Based on the update, here's the two-tier structure you can expect when your lab performs urine drug screens for Medicare beneficiaries:

For CLIA-waived or moderate complexity tests, per patient encounter (regardless of the number of drugs screened) report one unit of G0434 (Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter)

For CLIA high-complexity test methods, per patient encounter (regardless of the number of drugs screened), report G0431 (Drug screen, qualitative; multiple drug classes by high complexity test method [e.g., immunoassay, enzyme assay], per patient encounter).

Background: Several commentators at the Clinical Laboratory Fee Schedule (CLFS) annual public meeting last year suggested changing G0434 to include only CLIA waived and non-instrumented moderate complexity tests, while requesting a new code for moderate complexity instrumented tests with pricing at four times G0434.

The current grouping under G0434 treats drug screens by direct optical observation (DO) such as dipsticks, cups, or cards the same as non-DO moderate complexity instrumented test systems intended for repeated use, such as spectrophotometers, multi-channel chemistry analyzers, and fluorometers.

The G0434 grouping penalizes clinical labs that perform these tests using instrumented moderate complexity systems, according to Paul Radensky, representing McDermott Will & Emery LLP at the CMS public meeting. The moderate complexity instruments provide some clinical advantages, such as higher specificity, that commentators said should not be discouraged by coding and reimbursement.

One more restriction: In addition to setting the two-tier "G" codes in stone, the latest Policy Manual adds the following comment:

"If a provider performs urine drug screening, it is generally not necessary for that provider to send an additional specimen from the patient to another laboratory for urine drug screening for the same drugs."

That means physician offices using point-of-care drug screening should not additionally send off a urine specimen to an outside lab and expect Medicare to pay for both tests. Labs should be aware of this restriction and consult with physician clients to avoid denials in that scenario.