Pathology/Lab Coding Alert

Get ready for the new edition, which takes effect Jan. 1

If you-ve been wondering how you should report West Nile virus antibody tests and infectious agent detection methods for Aspergillus, enterovirus, Trichomonas vaginalis, and certain strains of Streptococcus and Staphylococcus, look no further than CPT 2007.

You-ll find these changes--plus about 20 other additions and revisions--in the  chart later in this issue. To avoid denials in 2007, you should use this chart to quickly master the changes that impact your lab coding. Save the chart to use as a handy reference tool throughout the year.

Learn New Codes for Microbial Infections

CPT 2007 adds six organism-specific codes to the microbiology section describing tests to identify Aspergillus, enterovirus, Streptococcus B, Trichomonas vaginalis, and Staphylococcus aureus--including the methicillin-resistant strain.

The AMA places the new codes into the method-based code families for enzyme immunoassay, nucleic acid, or immunoassay with direct optical observation, says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha. Within each code family, the new codes are in alphabetical order by organism.

Don't Use Unspecified Codes for Listed Organisms

When your lab tests a primary source for an infectious agent, you should report the most specific code available, says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore. But if CPT doesn't list a specific agent, you should use a general methodology code, according to CPT instruction.

Although you-ve had codes for nonspecific infectious agent tests all along, you should use six new, organism-specific codes starting Jan. 1 if you want to get paid correctly for the tests.

Old way: When you performed nucleic acid amplified probe technique for non-listed specimens such as enterovirus, Streptococcus group B and Staphylococcus aureus (and the methicillin-resistant strain), you reported 87798 (Infectious agent detection by nucleic acid [DNA or RNA], not otherwise specified; amplified probe technique, each organism),  Dettwyler says.

New way: Now you should report any of these tests with a new, specific code: 87498 for enterovirus, 87640 for Staphylococcus aureus, 87641 for methicillin- resistant Staphylococcus aureus, and 87653 for group B Streptococcus.

Similarly, you should now use 87305 for Aspergillus detection by enzyme immunoassay instead of 87449 (Infectious agent antigen detection by enzyme immunoassay technique qualitative or semiquantitative; multiple step method, not otherwise specified, each organism). Add 87808 to your code list for identifying Trichomonas vaginalis infection by direct optical observation instead of 87899 (Infectious agent detection by immunoassay with direct optical observation; not otherwise specified).

Don't miss: Although new codes 86788 and 86789 for West Nile virus antibodies are immunology codes, not microbiology codes, the same coding principal applies. You should now use these specific codes rather than reporting the service with 86790 (Antibody; virus, not elsewhere specified), Dettwyler says.

Update Lipoprotein and Molecular Diagnostics, Too

The clip-and-save chart shows other new codes you-ll have for 2007. You should use 82107 to bill for alpha-fetoprotein (AFP) L3 fraction isoform and total AFP, and 83698 for lipoprotein-associated phospholipase A2 (Lp-PLA2). CPT also adds 83913 for RNA stabilization so you can separately report that step when your lab performs it as part of a molecular diagnostics study. 

Keep in mind: Just because CPT introduces a new code, you aren't guaranteed payment for the service. Pathology/Lab Coding Alert will keep you up-to-date on coverage guidelines for these new and revised codes.