Pathology/Lab Coding Alert

Reserve 86355-86367 for "total count" immunology

If you found last year’s scattered cell-marker codes confusing, you’re not alone. CPT Codes 2006 renumbers the total-count codes so that they’re clustered around the existing lymphocyte T-cell series.

Although they are only a year old, you’ll have to stop using the following deleted codes:

• 86064--B cells, total count
• 86379--Natural killer (NK) cells, total count
• 86587--Stem cells (i.e., CD34), total count.

In their place, you should start using the following new codes:

• 86355--B cells, total count
• 86357--Natural killer (NK) cells, total count
• 86367--Stem cells (i.e., CD34), total count.

Don’t Use 86000 Codes for Neoplasm Immunophenotyping

Together with existing codes 86359 (T cells; total count), 86360 (… absolute CD4 and CD8 count, including ratio) and 86361 (… absolute CD4 count), new codes 86355, 86357 and 86367 describe total-cell-count lab tests. “Use codes 86355-86367 when the lab runs a quantitative flow cytometry test or panel for immunodeficiency, immune dysfunction and related analyses,” says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc., a pathology business practices publishing company in Simpsonville, Ky.

Avoid this: To ensure that you don’t use these codes as part of a flow-cytometry panel to assess cancer, such as leukemia or lymphoma, CPT 2006 adds the following note after 86367: “For flow cytometric immunophenotyping for the assessment of potential hematolymphoid neoplasia, see 88184-88189.”

Use 86586 for Unspecified Immunology Markers

What if the lab performs a total count for an unlisted cell type as part of an immunodeficiency panel? “The AMA’s in-house coding advisers state that we should use 86586 [Unlisted antigen, each] for unlisted cell types used to evaluate patients for immune dysfunction,” Padget says.

Although in the past you would have used the now-deleted flow-cytometry code 88180 (Flow cytometry; each cell surface, cytoplasmic or nuclear marker) for the unlisted antigen, that’s not the case anymore--not since CPT 2005 changed the codes for flow cytometry.

Don’t mix and match: Both the CPT text notes and the National Correct Coding Initiative (NCCI) say labs shouldn’t commingle the immunology “total count” codes with flow cytometry phenotyping codes 88184-88185 for the same panel because the latter are reserved for uses centered on “the assessment of potential hematolymphoid neoplasia.”

Clinical Lab Fee Schedule Pays Immunology

Labs often perform cell analyses to evaluate a patient’s immunologic status using methods that involve flow cytometry. To report these immunodeficiency panels, you should use clinical lab codes from the CPT immunology section, including new codes 86355, 86357 and 86367, which Medicare pays under the Clinical Laboratory Fee Schedule. “These immunology codes describe quantitative analyses that do not normally require a pathologist’s interpretation,” Padget says. “In the unusual event the patient’s attending physician asks a pathologist to interpret one of these tests or panels, report the service using generic clinical pathology consultation code 80500 or 80502, depending on the scope of the work.”

For example: The treating physician orders an immune dysfunction panel for her patient. The lab performs the test consisting of CD3 (total T cells), CD4 (helper cells), CD8 (suppressor cells), CD4/CD8 ratio, CD3/HLA-DR, CD8/CD38, CD8/CD28 and CD19 (B cells). The lab reports the results, with no morphologic review by the pathologist and no interpretive report.

You should report codes only from the immunology section for this immune-dysfunction evaluation panel. Report the service this way: 86359, T cell total count (CD3); 86360, CD4 and CD8 absolute counts and ratio; 86355, B cell total count; and 86586 x 3, HLA-DR, CD38 and CD28.

Physician Fee Schedule Pays Flow Cytometry

When you perform or interpret flow-cytometry studies for immunophenotyping of hematolymphoid cancers, use codes 88184-88189 to report the service.  “Report 88184 [Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker] and 88185 [… each additional marker (list separately in addition to code for first marker)] for the technical component of the study,”  says Peggy Slagle, CPC, billing compliance  coordinator at the University of Nebraska Medical Center in Omaha. Medicare pays 88184 and 88185 under the Physician Fee Schedule, but no physician labor cost is associated with them. “These are technical-only codes,” Slagle says.

The final step: For the pathologist’s professional interpretation of the panel, select the appropriate interpretation code based on the number of markers in the panel: 88187 for 2-8 markers, 88188 for 9-15 markers, and 88189 for 16 or more markers. “You should select one code to describe the interpretation of all flow cytometry markers for a single specimen,” Slagle says.