Pathology/Lab Coding Alert

Bonus clip-and-save chart gives you a handy new code preview.

From three new influenza tests to a specific test for tuberculosis, you'll have the inside scoop on upcoming lab code changes, thanks to this guide.

At its annual clinical laboratory public meeting on July 22, CMS provided a sneak peak at new lab test codes for CY 2011. The listing includes CPT codes that the AMA made available and HCPCS Level II codes from CMS. The code numbers are not finalized; X's represent unassigned digits. Make sure you're ready for the code changes outlined in the table at the end of this article.

Focus On Expanded Influenza Coding

CPT 2011 includes three new codes for influenza typing -- 875XX1-875XX3.

"The purpose of the codes is to recognize analyte-specific molecular detection of influenza virus types and subtypes," said Mary Steele Williams -- COO and director of scientific programs for the Association for Molecular Pathology (AMP) in Bethesda, Md. -- at the CMS public meeting.

Although influenza subtype detection has had recognized importance for some time, it regained significance with the novel H1N1 pandemic last year, according to Williams.

You'll select among these three codes based on whether the lab identifies a single type or subtype (875XX1) or two types/subtypes (875XX2), and any additional types/subtypes (875XX3 for each additional type or subtype).

Don't Miss New HIV Screening Options

You'll use one of three new G codes -- G0432, G0433, and G0435 -- to identify HIV screening for certain Medicare patients. The codes describe rapid tests for individuals at increased risk of contracting HIV, according to Jean S. Oglevee, LPN, CPC, director of coding, compliance and clinical services at Family Medicine Clifton/Centreville in Virginia.

You'll also use the codes for Medicare patients who receive rapid HIV testing at certain key points during pregnancy. Note that CMS says the definitions for these codes may change, and in fact, the agency has published different code definitions in other documents.

For the complete story, see "Reference 3 'G' Codes for Early HIV Screening" in Pathology/Lab Coding Alert Vol. 11, No. 7.

Watch for CMS Pricing Recommendations

CMS received industry input during the July 22 public meeting for the new clinical laboratory codes. You'll be able to view the CMS pricing recommendations in September at

www.cms.gov/ClinicalLabFeeSched, according to CMS contact Glenn McGuirk.

Expect crosswalk: Although payment method for codes can be either crosswalk (paying at the same rate as a comparable existing code) or gap-fill (pricing a code based on analysis of annual carrier payment rates), almost all presenters at the public meeting recommended crosswalks for the new codes.