Pathology/Lab Coding Alert

Although most of the CPT Codes 2003 changes that affect laboratories and pathology practices clarify procedures you already perform, you should refamiliarize yourself with the altered codes to ensure proper coding.

"Most of the new lab codes this year do not involve novel or unique technologies," says Stephen N. Bauer, MD, FCAP, the College of American Pathologist's (CAP) representative to the AMA's CPT Advisory committee.

Although only hematology, cervical cytology and stem cell services encompass significant modifications, you need to know how other changes might impact your lab. The modified codes go into effect Jan. 1, 2003, for Medicare, although some carriers and third-party payers may take longer to implement them.

"Even if your insurers allow a three-month grace period before requiring these codes, you should not wait until April 1 to learn how to use them," says Laurie Castillo, MA, CPC, CPC-H, CCS-P, member of the National Advisory Board of the American Academy of Professional Coders and president of Physician Coding and Compliance Consulting in Virginia.

(See "CPT 2003 Overhauls Hematology Codes" in this issue for a complete discussion of blood service code changes, and upcoming issues of Pathology/Lab Coding Alert for analysis of stem cell and cervical cytology changes.)

Use New Codes for Specific Reporting

"With few new procedures, most codes added in CPT 2003 either replace or expand on existing codes for a similar service," Castillo says.

CPT 2003 adds two new codes for specific direct fluorescent antibody (DFA) tests, replacing two codes for the same procedures that were added just last year. "The two codes added last year, 87198 (Cytomegalovirus, direct fluorescent antibody [DFA]) and 87199 (Enterovirus, direct fluorescent antibody [DFA]), were really just in the wrong place," Castillo says. The codes were listed in microbiology as stand-alone codes in CPT 2002, but the 2003 version deletes the old codes and moves the tests to the family of codes for infectious agent antigen detection by immunofluorescent technique ... (87260-87300). You should now report these specific DFA tests with the following new codes:

Another new microbiology code is 87255 (Virus isolation; including identification by non-immunologic method, other than by cytopathic effect [e.g., virus specific enzymatic activity). "This code reports virus isolation by methods other than immunofluorescence stain, which is described by the preceding code (87254)," Castillo says.

Two new chemistry codes in CPT 2003 allow more specific coding. For example, you should report a B-Natriuretic peptide test, which may be used to aid in congestive heart failure diagnosis, with new code 83880 (Natriuretic peptide). A new test for sodium from sources other than serum or urine should be reported with 84302 (Sodium; other source). An amended note under 89360 (Sweat collection by iontophoresis) directs you to the new code for other-source sodium analysis (84302) and to the existing code for other-source chloride analysis (82438, Chloride; other source). For sweat collection followed by sodium and chloride tests of the specimen, report all three codes.

Report new code 89055 (Leukocyte count, fecal) for stool leukocyte tests that you formerly reported using HCPCS Level II code G0026 (Fecal leukocyte examination), Castillo says. Physicians may order this test to identify fecal mucus from infections such as dysentery.

CPT 2003 adds three new Category III codes for lab services. "Although these are temporary codes, when a Category III code is available to report a specific service you must use it rather than using a nonspecific or unlisted Category I code," Castillo says. Check with payers to ensure they recognize these codes. Category III codes are temporary listings that describe emerging technology, services and procedures. They allow for data collection about specific services that may not be widely practiced or FDA-approved, as are Category I codes. The Category III codes may eventually receive Category I code numbers.

The new lab Category III codes are as follows:

A note in the CPT immunology section, near other phospholipid antibody tests (86147, 86148), directs readers to this new listing, which represents an antibody test to assess patients who may be at risk for, among other things, fetal loss.

A note under 82376 directs coders to 0043T to report end-tidal carbon monoxide.

Know How to Report Services for Deleted Codes

Just because CPT deletes a code doesn't mean you have no way to report the service should your lab continue to perform it. For instance, CPT 2003 replaced two deleted codes with new codes for the same service. As previously mentioned, CPT 2003 deleted 87198 and 87199 for Cytomegalovirus and Enterovirus DFA tests and replaced them with new codes 87271 and 87267 for the same procedures.

Similarly, CPT 2003 deleted 80090 (TORCH antibody panel), but you can still report the service using existing codes for each of the individual lab tests. If your lab continues to perform this group of tests, report the service as 86644 (Antibody; cytomegalovirus [CMV]), 86694 (Antibody; herpes simplex, non-specific type test), 86762 (Antibody; rubella) and 86777 (Antibody; toxoplasma). "Just as when you reported the panel code, you must have medical-necessity documentation to justify each of these tests when you run them together," Castillo says.

Understand the Impact of Code Modification

CPT 2003 revised 89310 (Semen analysis; motility and count [not including Huhner test]) specifically to exclude Huhner (post-coital) testing. Code 89310 will replace HCPCS Level II code G0027 (Semen analysis; presence and/or motility of sperm excluding Huhner test). This revision distinguishes 89310, which is often used for sperm count for fertility testing or sterilization-reversal assessment, from 89300 (Semen analysis; presence and/or motility of sperm including Huhner test [post-coital]) for evaluating cervical mucus receptivity to sperm. This change does not affect reporting a standard postvasectomy semen analysis using 89321 (Semen analysis, presence and/or motility of sperm).

Other code revisions include 87254 (Virus isolation; centrifuge-enhanced [shell vial] technique, includes identification with immunofluorescence stain, each virus), which now specifies a centrifuge-enhanced procedure and places shell vial in parentheses because this terminology is not universal. Code 87207 (Smear, primary source with interpretation; special stain for inclusion bodies or parasites [e.g., malaria, coccidia, microsporidia, trypanosomes, herpes viruses]) no longer contains reference to cytomegalovirus because there is a new, specific code for that virus, 87271. New notes in CPT 2003 clarify that you should use 87207 for direct smears from primary source and 87177 (Ova and parasites, direct smears, concentration and identification) for concentration of smears from primary source.