Pathology/Lab Coding Alert

You’ll need to learn yet another IHC-stain paradigm shift.

Forewarned is forearmed, so let us take you on a whirlwind tour of what you can expect for 2015 lab and pathology procedure coding.

Last month, you learned a bit about a massive number of changes in “Expect Drug Testing Overhaul Next Year” (Pathology/Lab Coding Alert, Vol. 15 No. 9). This month we’ll give you a foretaste of the other changes you can expect in CPT® 2015. 

For a roundup of most of the CPT® 2015 changes you’ll need to know for your lab, see “Get Familiar With CPT® 2015 Lab and Pathology Code Changes” on page 76 of this issue. 

Update Molecular Pathology

CPT® 2015 creates a family of codes in the Tier 1 Molecular Pathology section for FLT3 (fms-related tyrosine kinase 3) gene analysis for conditions such as acute myeloid leukemia. Where you currently have one code for internal tandem duplication variants (exons 14, 15), CPT® 2015 revises that code (81245) as the parent code and adds intended codes 81246 (… tyrosine kinase domain [TKD] variants [e.g., D835, I836]) and 81288, which is out of numerical sequence (… promoter methylation analysis).

Tier 2: You’ll also see some significant changes in the Tier 2 codes, notably the addition of tests for blood typing using antigen gene analysis methods instead of traditional serological techniques. These new descriptors appear under 81403 (Molecular pathology procedure, Level 4 [e.g., analysis of single exon by DNA sequence analysis, analysis of >10 amplicons using multiplex PCR in 2 or more independent reactions, mutation scanning or duplication/deletion variants of 2-5 exons]), as follows:

• Human erythrocyte antigen gene analyses (e.g., SLC14A1  [Kidd blood group], BCAM [Lutheran blood group], ICAM4 [Landsteiner-Wiener blood group], SLC4A1 [Diego blood group], AQP1 [Colton blood group], ERMAP [Scianna blood group],  RHCE ]Rh blood group, CcEe antigens], KEL [Kell blood group], DARC [Duffy blood group], GYPA, GYPB, GYPE  [MNS blood group], ART4 [Dombrock blood group]) (e.g., sickle-cell disease, thalassemia, hemolytic transfusion reactions, hemolytic disease of the fetus or newborn), common variants
  
• RHD (Rh blood group, D antigen) (e.g., hemolytic disease of the fetus and newborn, Rh maternal/fetal compatibility), deletion analysis (e.g., exons 4, 5, and 7, pseudogene)
  
• RHD (Rh blood group, D antigen) (e.g., hemolytic disease of the fetus and newborn, Rh maternal/fetal compatibility), deletion analysis (e.g., exons 4, 5, and 7, pseudogene), performed on cell-free fetal DNA in maternal blood.
  

The addition of these test descriptors will allow coders to distinguish between blood typing tests for red blood cell groups such as Kidd, Kell, and Duffy using gene analysis techniques instead of more traditional blood-typing methods. To clarify the method differences in the codes, CPT® 2015 adds the word “serologic” to the existing code descriptors for blood-type testing (86900-86906 (Blood typing, serologic; …).

Do this: “Make sure to continue reporting the appropriate code from the range 86900-86906 when your lab uses traditional serologic blood typing methods, and reserve 81403 for any of the gene analysis blood typing tests you perform beginning in 2015,” advises William Dettwyler, MT AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore. 

Engage New Genomic Sequencing Section

You can expect a new section in CPT® 2015 for genomic sequencing procedures (GSPs) and other molecular multianalyte assays. These codes for next-generation molecular tests describe genomic sequencing analysis for conditions such as colon cancer, aortic dysfunction, nonsyndromic hearing loss, X-linked intellectual syndrome, and whole exome/genome tests such as whole mitochondrial genomic sequencing. 

You’ll find 21 new codes in this section, ranging from 81410 to 81471. Look to future issues of Pathology/Lab Coding Alert for an in-depth discussion of these new codes. 

Keep Up With Microbiology Changes

You’ll face several microbiology changes in CPT® 2015, such as minor wording changes to include reverse transcription in multiplex infectious agent codes. For instance, the new code set changes the code descriptor of several codes from “multiplex reverse transcription …” to “includes multiplex reverse transcription, when performed, …” Look for 87501-87503 influenza tests, as well as 87632-87633 respiratory virus tests to include this change in 2015.

This change parallels revisions in the 2014 codes to alter “reverse transcription and amplified probe technique” to “amplified probe technique, includes reverse transcription when performed.” Because the reverse transcription step is not required for the amplified probe codes or the multiplex codes mentioned above, the new language allows coders to accurately report the codes even if the lab does not carry out the reverse transcription step.

There’s more: Other microbiology changes for next year are more substantial. For instance, CPT® 2015 reworks HPV coding by deleting 87620-87622 (Infectious agent detection by nucleic acid [DNA or RNA]; papillomavirus, human, direct probe technique/amplified probe technique/quantification). In place of those codes, you’ll find the following three new codes:

• 87623 — Human Papillomavirus (HPV), low-risk types (e.g., 6, 11, 42, 43, 44)
• 87624 — Human Papillomavirus (HPV), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68)
• 87625 — Human Papillomavirus (HPV), types 16 and 18 only, includes type 45, if performed.

“This change may be significant for payment, since many payers will cover testing for high-risk HPV types, but not low-risk HPV types under certain clinical circumstances,” says R.M. Stainton Jr., MD, president of Doctors’ Anatomic Pathology Services in Jonesboro, Ark. 

Understand IHC and ISH Unit of Service

CPT® 2015 brings much-needed clarification to qualitative and quantitative immunohistochemistry (IHC) coding, and coordinates the coding principles with how you should report in situ hybridization (ISH) as well. By deleting, adding, and revising codes in the range +88341 to 88344 and 88360 to 88377 (some codes out of numerical sequence), CPT® 2015 establishes the unit of service as specimen, not block, and provides distinct codes for single versus multiplex stains. Look to future issues of Pathology/Lab Coding Alert for a complete explanation of how to use these codes, and what the changes will mean for your bottom line.

Back story: When code changes for qualitative IHC hit the presses for 2014, much confusion ensued, including Medicare’s implementation of alternative “G” codes (see Pathology/Lab Coding Alert, Vol. 14 No. 12 and Vol. 15 No. 3). Much of the muddle surrounded the unit of service — block versus specimen, and single versus multiplex stains (with or without “separately identifiable antibodies”). Even with an understanding of how to use the codes, experts noted the disparities that the codes created between qualitative versus quantitative IHC (Pathology/Lab Coding Alert, Vol. 15, No. 5). The CPT® 2015 changes to these codes should add clarity and uniformity to coding and payment for these services.