Pathology/Lab Coding Alert

Watch for new Mohs edits, too

Coding principle: You can't bill for a primary-source infectious agent identification and a culture-method identification for the same test. That's the basis of four new edit pairs in Correct Coding Initiative (CCI) version 14.1, effective April 1.
 Exception: You might be able to override the edit pairs for distinct organisms. Let our experts show you when and how -quot; so you can capture every penny you deserve.

Beware New CCI Edit Pairs

CCI 14.1 bundles the following four codes with 87253 (Virus isolation; tissue culture, additional studies or definitive identification [e.g., hemabsorption, neutralization, immunofluorescence stain], each isolate):
- 87305 -quot; Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Aspergillus
- 87640 -quot; Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, amplified probe technique
- 87641 -quot; - Staphylococcus aureus, methicillin resistant, amplified probe technique
- 87653 -quot; - Streptococcus, group B, amplified probe technique.

 -These edit pairs add to a long list of CCI edits that restrict reporting primary-source infectious agent detection codes for a specific bacterial organism with culture identification codes or virus identification codes for the same specimen,- says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.
 Here's why: -The culture codes represent a different methodology and a different source, so you should never report those tests for the same specimen that your lab uses to identify an organism from a primary source,- Dettwyler says.
 Exception: -But if your lab isolates and definitively identifies a virus from tissue culture on the same day as one of the primary-source bacterial identifications, you-ll have to use modifier 59 (Distinct procedural service) to override these 87253 edit pairs,- he says.

Micro Basics: Choose the Most Specific Identification

 Keep in mind the following infectious-agent coding principles so you can understand and avoid the CCI pitfalls:
 When your lab identifies a specific infectious agent from a primary source, not a culture, you should select the most specific code from the range 87260-87899 based on the lab method and organism identified, Dettwyler says.
 For instance: If your lab identifies Chlamydia trachomatis using an amplified probe technique, you should report 87491 (Infectious agent detection by nucleic acid [DNA or RNA]; Chlamydia trachomatis, amplified probe technique).
 Be specific: You would select 87491 instead of the -generic- method code that does not specify the organism (87798, Infectious agent detection by nucleic acid [DNA or RNA], not otherwise specified; amplified probe technique, each organism).
 Similarly, you should select the organism code that matches the method your lab used, not another method, such as 87270 (Infectious agent antigen detection by immunofluorescent technique; Chlamydia trachomatis). Never report two different identification methods for the same organism, or you-re likely to face a CCI edit pair.
 Avoid this: Don't confuse cultures and tissue cultures with primary-source identification methods.

Know Mohs Stain Bundle Exception

 CCI 14.1 also added a new edit pair that bundles special stains as a component with Mohs for the following two codes:
- 17313 -quot; Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (e.g., hematoxylin and eosin, toluidine blue), of the trunk, arms, or legs; first stage, up to 5 tissue blocks
- +88312 -quot; Special stains (list separately in addition to code for primary service); Group I for microorgan-isms (e.g., Gridley, acid fast, methenamine silver), each.

 Prior CCI versions already bundled 17313 with other stain codes. CCI also had edit pairs in place for the -other-site- Mohs code (17311, Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain[s] [e.g., hematoxylin and eosin, toluidine blue], head, neck, hands, feet, genitalia, or any location with surgery directly involving muscle, cartilage, bone, tendon, major nerves, or vessels; first stage, up to 5 tissue blocks) with all stain codes, including 88312.
 Oversight: Adding an edit pair for 17313 and 88312 appears to rectify an earlier CCI oversight that omitted only this Mohs/special stain code combination.
 What it means: As part of the histopathologic preparation, Mohs procedures include -routine stain(s) (e.g., hematoxylin and eosin, toluidine blue),- according to the code definitions. That means for routine stains involved with Mohs, you shouldn't unbundle the service and additionally report special stain codes such as:
- +88312 -quot; Special stains (list separately in addition to code for primary service); Group I for microorganisms (e.g., Gridley, acid fast, methenamine silver), each
- +88313 -quot; - Group II, all other (e.g., iron, trichrome), except immunocytochemistry and immunoperoxidase stains, each
- +88314 -quot; - histochemical staining with frozen section(s)
- 88342 -quot; Immunohistochemistry (including tissue immunoperoxidase), each antibody.

 Exception: If the physician performs an additional stain that is not a typical part of Mohs tissue processing, you can use the appropriate special stain code in addition to the Mohs codes. -For example, the physician might examine a PAS stain if he suspects a fungal infection, which would warrant reporting 88312 in addition to the Mohs codes,- says R.M. Stainton Jr., MD, president of Doctors- Anatomic Pathology Services in Jonesboro, Ark.
 Do this: Append modifier 59 to 88312 to ensure that your payer knows the physician performed a true -special stain- and did not unbundle a routine stain such as H&E.