Pathology/Lab Coding Alert

Fetal evaluations and STD infection diagnosis at stake.

You might see more lab test orders for patients from you ob/gyn clients thanks to one revised and two new codes in CPT® 2014.

Read on to ensure that you make the most of these opportunities for your lab by getting familiar with the tests and the codes.

Focus on Fetal Evaluations

Ob-gyns may want to test patients early in the pregnancy for fetal aneuploidy to evaluate the likelihood of certain fetal conditions such as trisomy 21 (Down Syndrome). Now labs can offer a test that uses the plasma of pregnant women for noninvasive prenatal testing. The test uses cell free fetal DNA to screen for fetal aneuploidy.

Beginning Jan. 1, you’ll have a new CPT® code to report this test: 81507 (Fetal aneuploidy [trisomy 21, 18, and 13] DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy).

That’s not all: With a code revision, CPT® 2014 creates a way to report a broader spectrum of tests on cervicovaginal fluid specimens than you could report in the past. For the new year, CMS revises 84112 (existing definition: Placental alpha microglobulin-1 [PAMG-1], cervicovaginal secretion, qualitative) to a broader definition.

The new definition allows you to use the code to report tests for various proteins, not just PAMG-1: (Evaluation of cervicovaginal fluid for specific amniotic fluid protein[s] [e.g., placental alpha macroglobulin-1 (PAMG-1), placental protein 12 (PP12), alpha-fetoprotein], qualitative, each specimen).

The ob-gyn might order this test to identify premature rupture of membranes (PROM) based on the presence of PAMG-1. Of you might see orders for proteins such as placental protein 12 (PP12) for evaluating other pregnancy risk.

These are tests that wouldn’t be carried out in the ob/gyn office CLIA waived lab, according to Melanie Witt, RN, CPC, COBGC, MA, an independent coding consultant based in Guadalupita, N.M. That means your lab might have new opportunities to report 81442 in 2014.

Expect Broader Trich Code Choices

Trichomoniasis is a common sexually transmitted disease (STD) that affects more than 160 million people worldwide. The infection is of particular concern in pregnancy because it’s associated with premature, low-birth weight babies.

The disease is caused by a protozoan parasite, Trichomonas vaginalis. CPT® currently provides infectious agent antigen detection codes to report tests for the organism, such as:

• 87808 — Infectious agent antigen detection by immunoassay with direct optical observation; Trichomonas vaginalis
• 87660 — Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, direct probe technique.

New code: Now CPT® 2014 adds a new code for a test for the organism:

• 87661 — Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, amplified probe technique

This addition provides a specific code to report testing for Trichomonas vaginalis by amplified probe technique.

“Prior to the addition of 87661, coders may have reported this test with the general methodology code 87798 (Infectious agent detection by nucleic acid [DNA or RNA], not otherwise specified; amplified probe technique, each organism),” says William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.