Pathology/Lab Coding Alert

Stop using general codes for analyte-specific tests.

You have 15 new codes scattered throughout the pathology/laboratory CPT chapter, so how will you find what you need to know? Let us help you jump-start your 2010 claims with this how-to inventory. "From chemistry to surgical pathology, you'll find new codes in CPT 2010 that you need to know," says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha.

Read through our section-by-section account to discover which tests have new codes that you need to know.

Can't Miss Chemistry Changes

CPT 2010 has three new chemistry codes:

• 83987 -- pH; exhaled breath condensate

• 84145 -- Procalcitonin (PCT)

• 84431 -- Thromboxane metabolite(s), including thromboxane if performed, urine.

In addition to the new pH code (83987), CPT 2010 revises pH code 83986 to change "except blood" to "not otherwise specified" (83986, pH; body fluid, not otherwise specified).

"The change clarifies what has been proper coding all along -- that you should not use 83986 for urine pH, because existing urinalysis codes 81000-81003 describe that test," says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Focus on Specific Immunology Codes

Three new immunology codes give your lab more specific means to report certain tests, as follows:

• Ovarian cancer marker: 86305 -- Human epididymis protein 4 (HE4)

• Transplant management immune function marker: 86352 -- Cellular function assay involving stimulation (e.g., mitogen or antigen) and detection of biomarker (e.g., ATP)

• Syphilis diagnosis: 86780 -- Antibody; Treponema pallidum.

"These codes allow more specificity in reporting. For instance, you can use 86305 for HE4 starting January 1 rather than using generic code 86316 (Immunoassay for tumor antigen, other antigen, quantitative [e.g., CA 50, 72-4,549), each) for the test," Dettwyler says.

Don't Miss Tissue Typing Crossmatch

Two new codes for human leukocyte antigen (HLA) crossmatch represent tests that could help reduce the occurrence of transplant rejection. The following codes describe newer tests using methods such as flow cytometry:

• 86825 -- Human leukocyte antigen (HLA) crossmatch, non-cytotoxic (eg, using flow cytometry); first serum sample or dilution

• 86826 -- Human leukocyte antigen (HLA) crossmatch, non-cytotoxic (eg, using flow cytometry); each additional serum sample or sample dilution (List separately in addition to primary procedure).

"You should report 86825 for the first serum sample or dilution, and add 86826 each time the lab tests another serum sample or performs an additional dilution to quantify the strength of the antigen/antibody reaction," Dettwyler says.

Specify Culture Typing With New Microbiology Codes

CPT already provides six method-specific culture typing codes (87140-87158, Culture, typing ...). "Now CPT 2010 adds two more method-specific culture typing codes," Dettwyler says:

• 87150 -- Culture, typing; identification by nucleic acid [DNA or RNA] probe, amplified probe technique, per culture or isolate, each organism probed

• 87153 -- Culture, typing; identification by nucleic acid sequencing method, each isolate (e.g., sequencing of the 16S rRNA gene).

Also look for the new, specific code for C. diff by amplified probe technique (87493, Infectious agent detection by nucleic acid (DNA or RNA); Clostridium difficile, toxin gene[s], amplified probe technique).

"Before Jan. 1, you would report this test using the generic code 87798 (Infectious agent detection by nucleic acid [DNA or RNA], not otherwise specified; amplified probe technique, each organism)," Dettwyler says.

Grab This Surgical Pathology Opportunity

Labs have been prepping tissue for ancillary studies, such as molecular diagnostics, for as long as the tests have been around. But you have never had a code to capture your lab's work -- until now. Two new surgical pathology

codes describe this type of tissue preparation:

• 88387 -- Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (e.g., nucleic acid-based molecular studies); each tissue preparation (e.g., a single lymph node)

• 88388 -- Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (e.g., nucleic acid-based molecular studies); in conjunction with a touch imprint, intraoperative consultation, or frozen section, each tissue preparation (e.g., a single lymph node) (List separately in addition to code for primary procedure).

"Note that you'll report 88388 in addition to the primary procedure, such as 88161 (Cytopathology, smears, any other source; preparation, screening and interpretation), 88329 (Pathology consultation during surgery), 88331 (... first tissue block, with frozen section[s], single specimen), or 88333 (... cytologic examination [e.g., touch prep, squash prep], initial site)," Dettwyler explains.

Learn These New In Vivo Laboratory Codes

After adding a section for in vivo testing last year, CPT adds a new code to the section in 2010 for a test that can aid in anemia and transfusion management: 88738 (Hemoglobin [Hgb], quantitative, transcutaneous).

Look for Unlisted Reproductive Medicine Code

You'll have a new reproductive medicine code in 2010: 89398 (Unlisted reproductive medicine laboratory procedure).

"Not ending an ‘unlisted procedure' code with ‘99' is unusual, and might help avoid certain payer software edits that automatically reject codes ending in ‘99,'" Dettwyler says.

Editor's Note: Zero in on CPT changes you need to know with "2010 Pathology Coding Updates" presented by Peggy Slagle, Wednesday, December 16, 2009. Go to www.audioeducator.com/conference-2010-Pathology-Coding-Update-0712 to register.