Pathology/Lab Coding Alert

Get specific and earn $44.08 for NMR lipoprotein quantitation

Clarify your lipid coding with CPT’s new analyte code and three new method codes: Not only will you more easily select the proper code--you’ll also get paid more for certain procedures.

Look for New Cluster of Lipoprotein Codes

CPT 2006 rearranged some lipoprotein codes to accommodate an assay that labs have begun to use more frequently. “You should stop using the deleted codes and begin using the new ones as of Jan. 1,” says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore. 

Old way: Beginning in January, don’t use the following codes, which CPT Codes 2006 deletes:

• 83715--Lipoprotein, blood; electrophoretic separation and quantitation

• 83716--… high resolution fractionation and quantitation of lipoproteins including lipoprotein subclasses when performed (e.g., electrophoresis, nuclear magnetic resonance, ultracentrifugation).

New way: Instead, you should choose one of the following three new codes for the same tests you’ve been performing based on these new descriptions:

• 83700--Lipoprotein, blood; electrophoretic separation and quantitation

• 83701--… high resolution fractionation and quantitation of lipoproteins including lipoprotein subclasses when performed (e.g., electrophoresis, ultracentrifugation)

• 83704--… quantitation of lipoprotein particle numbers and lipoprotein particle subclasses (e.g., by nuclear magnetic resonance spectroscopy).

Part of the change involves simply renumbering codes, but part of it is breaking one code into two separate codes based on methodology. “Notice that new code 87300 has the same definition as deleted code 83715,” Dettwyler says.

“But CPT 2006 divides deleted code 83716 into two new codes--83701 and 83704--based on lab method,” he explains. NMR spectroscopy for lipoprotein analysis has become more common and now has its  own code.

Watch out: Labs that presently bill 83716 for lipoprotein fractionation and quantitation regardless of method need to switch to the new codes. “Beware of using only the new text notes to decide which code to use,” Dettwyler cautions. Two errors in the text notes could lead you astray.

1. The note following 83704 reads, “83715, 83716 have been deleted. To report, use 83700, 83701.”
“The note doesn’t mention that you should use 83704 in place of 83716 when you’re reporting lipoprotein particle subclass quantitation by nuclear magnetic resonance (NMR) spectroscopy,” Dettwyler says.

2. The note following 83721 states, “For lipoprotein particle numbers and subclasses analysis by nuclear magnetic resonance spectroscopy, use 83695.”

“The note should say, ‘use 83704,’” Dettwyler says. At the AMA coding conference in November 2005, Mark S. Synovec, MD, substituted 83704 in this text note and pointed out that it constitutes a change from the CPT 2006 manual printing that lists 83695. 
 
Opportunity: You’ll want to be sure to report 83704 when your lab performs quantitation of lipoprotein particles using NMR spectroscopy because the 2006 Clinical Laboratory Fee Schedule pays more for this code than for 83701. The national limit amount for 83704 is $44.08, while 83701 pays $34.68--the same as deleted code 83716.

Use New Analyte Code for Lipoprotein (a)

Physicians frequently order Lipoprotein (a) as an independent marker for heart disease. Until now, labs haven’t had a clear choice about how to code the test. “Labs have had to select a code that describes the lab method, such as 83883 (Nephelometry, each analyte not elsewhere specified) or 83520 (Immunoassay, analyte, quantitative; not otherwise specified),” Dettwyler says. Although not an accurate selection, some labs have been known to report 82172 (Apolipoprotein, each) for lipoprotein (a).

Problem solved: CPT 2006 introduces a new, analyte-specific code for the test: 83695 (Lipoprotein [a]). “Regardless of lab method, you should now report 83695 when your lab runs a blood test for lipoprotein (a),” Dettwyler says.

The bottom line: Despite having a new code, you shouldn’t expect your payment to change much. New code 83695 pays $18.09 (national limit amount)--the same as the commonly-used method code 83520.