Pathology/Lab Coding Alert

Use new -unit of service- definitions to capture every dollar.

When you-re billing for molecular diagnostics studies that involve steps to extract, isolate, and otherwise manipulate nucleic acids, you need to know about CPT 2009 code changes to keep your claims clean.

Follow our experts- advice to learn when you can -- and can't -- code for multiple nucleic acid manipulations as part of a single molecular diagnostics assay.

When labs perform molecular diagnostics techniques to analyze nucleic acids, you should use 83890-83914 to report the service. "Each code describes a separate technique, such as nucleic acid extraction or gene amplification, and you should report each step using the appropriate code," explains Elizabeth Sheppard, HT(ASCP), senior manager of technical marketing for Ventana Medical Systems in Tucson, Ariz.

CPT 2009 revises eight codes in this molecular diagnostics code range. Physicians order molecular diagnostic testing to diagnose and direct treatment relating to infectious agents and disease markers, inherited disorders, and oncology.

You-ve had codes for nucleic acid extraction, separation, and transfer for years, but CPT 2009 revises the definitions for clarity.

"The intent of the code changes is to remove ambiguity regarding when you can report multiple units of the same code for a single molecular diagnostics study," says Diana Voorhees, MA, CLS, MT (ASCP) SH, CLCP, principal with DV and Associates Inc. in Salt Lake City.

CPT removes that ambiguity by defining the unit of service for eight molecular diagnostics codes.

Note the changes: The unit of service is "nucleic acid type" for the following codes (new 2009 text underlined):

- 83890 -- Molecular diagnostics; molecular isolation or extraction, each nucleic acid type (i.e., DNA or RNA)

- 83891 -- - isolation or extraction of highly purified nucleic acid, each nucleic acid type (i.e., DNA or RNA)

The unit of service for certain other codes is "nucleic acid preparation" (new 2009 text underlined):

- 83893 -- - dot/slot blot production, each nucleic acid preparation

- 83894 -- - separation by gel electrophoresis (e.g. agarose, polyacrylamide), each nucleic acid preparation

- 83897 -- - nucleic acid transfer (e.g., Southern, Northern , each nucleic acid preparation

- 83909 -- - separation and identification by high resolution technique (e.g., capillary electrophoresis), each nucleic acid preparation.

CPT 2009 also makes these two additional molecular diagnostics changes to clarify the unit of service:

- 83892 -- - enzymatic digestion, each enzyme treatment

- 83907 -- - lysis of cells prior to nucleic acid extraction (e.g., stool specimens, paraffin embedded tissue), each specimen.

These changes won't necessarily alter how you code. Whether you need to make a change depends on how you interpreted the codes in the past. According to the AMA, the revised codes tell you how you should have been using the codes all along.

In fact, CPT 2009 Changes, An Insider's View, states that the AMA made these changes "to better clarify the original intent of these codes."

"But the old definitions left coders in limbo, and some believed that if the code did not specify the unit of service, you should only report it once for a particular molecular assay," Voorhees says.

For instance: Some experts advised that you should only report gel electrophoresis (83894) or enzyme digestion (83892) once per assay because the 2008 code definitions didn't specify -each,- according to Voorhees.

On the other hand, some experts had used 83892 once per enzyme cleavage, and the new description, "per enzyme treatment," could mean fewer units of 83892.

For example: "Under the old code definition, laboratories using Invader- technology have reported 83892 x 4 for Factor V Leiden testing since it involved four enzyme cleavages, but under the new definition, only one unit of 83892 is supported for the test," says Stephen Day, PhD, director of medical affairs for Third Wave Technologies/ Hologic in Madison, Wis.

To further clarify the definition for molecular diagnostics unit of service, the AMA added a paragraph following 83887 to define "nucleic acid preparation."

New text note: CPT 2009 adds this text note at the beginning of the molecular diagnostics codes as follows:

"Each nucleic acid preparation may include a digestate, undigested nucleic acid, or other uniquely modified nucleic acid sample (e.g., newly synthesized oligonucleotide)."

"Coders should find this definition helpful because it lets you know that you can bill for each step carried out on the specimen to prepare different nucleic acid samples," Voorhees says.

You-ll need to make sure you avoid some coding pitfalls inherent in the CPT revisions.

Caution: Just because you see that an assay involves both DNA and RNA, you can't necessarily charge for different sources. You-ll have to make sure the lab actually performed two separate extractions before you report two units of 83890 or 83891.

Here's why: "Labs often acquire RNA by reverse transcription from an isolated DNA sample, and that's a different procedure than RNA isolation and extraction," Voorhees says.

Do this: If the lab uses reverse transcriptase to produce the RNA sample, report 83902 (Molecular diagnostics; reverse transcription).

Make sure you don't use the CPT code revisions as an excuse to report multiple steps that aren't medically necessary. For instance, some molecular diagnostics assays involve two gel electrophoresis steps, one of which ensures adequate nucleic acid material for the test. Even with the 83894 revision, expert opinions may vary about charging 83894 x 2, or charging 83894 because one step is for "quality control," according to Voorhees.

Similarly, the lab shouldn't perform and report two isolations for two assays if enough genetic material is available from a single isolation and extraction.