Pathology/Lab Coding Alert

Pick up on phospholipid code changes, too.

If you've been wondering how to report the PAMG-1 test for your obstetric clients or how to code the recent hexagonal phospholipid neutralization lupus test, newly-created CPT 2011 codes will show you the way starting Jan. 1.

Read on to get our experts' take on these and other new codes.

You'll Want to Catch PAMG-1 -- Here's How

CPT 2011 introduces a new code that will help you get paid when a physician orders a placental alpha microglobulin-1 (PAMG-1) test to identify premature rupture of membranes (PROM). The new code is 84112 (Placental alpha microglobulin-1 (PAMG-1), cervicovaginal secretion, qualitative).

"This is a diagnostic test that determines if a pregnant woman's membranes are ruptured," according to Michael Basco, M.D., P.A. -- chief of perinatal services at North Texas Community Hospital in Bridgeport - at the CMS annual clinical laboratory public meeting. "Using this test lowers the cost of care and improves the quality of care," he says.

Changes Make Phospholipid Code Family

You have a new code for lupus anticoagulant identification in CPT 2011 -- and a revised code to accommodate the addition.

The test is a phospholipid neutralization assay, and CPT 2010 already includes 85597 (Platelet neutralization), which is also a phospholipid neutralization. The lupus test involves hexagonal phospholipid neutralization.

"To accommodate both tests, CPT 2011 creates a new code family for phospholipid neutralization," explains William Dettwyler, MT AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

The parent code is revised code 85597 (Phospholipid neutralization; platelet) and the indented code is the new code 85598 (... hexagonal phospholipid).

Clarify coding: "Some labs have been using 85997 for the hexagonal phospholipid test -- that is not correct, and adding the new code should clarify the issue," Dettwyler says. More Changes Add Specificity CPT 2011 confirms how you should have been using 82952 (Glucose; tolerance test, each additional beyond 3 specimens) all along by adding this parenthetic phrase to the code definition: (List separately in addition to code for primary procedure).

"Billing departments are notorious for misunderstanding 82952, so adding this phrase might make it clearer," Dettwyler says.

Do this: Report 82951 (Glucose; tolerance test [GTT], 3 specimens [includes glucose]) for the first three glucose tolerance test specimens, and 82952 for each additional specimen beyond three, according to Dettwyler. "Most labs do four or five sugars, and labs might not be catching 82952 like they should."

Don't miss 'emerging technology' codes: Make sure you notice the Category III additions, because they give you new, specific codes to use, notes Susan Vogelberger, CPC, CPC-H, CPC-I, CMBS, CCP-P, CEO of Healthcare Consulting and Coding Education in Boardman, Ohio.

"If a lab is currently running the skin advanced glycation endproducts test, they'll need to start reporting 0233T (Skin advanced glycation endproducts [AGE] measurement by multi-wavelength fluorescent spectroscopy) on Jan. 1 instead of an unlisted code," Dettwyler agrees.

Get ahead: Make sure you're ready for these and other new and revised CPT 2011 lab codes outlined in the following "Clip"and"Save" chart.