Pathology/Lab Coding Alert

Watch CMS for final pricing decisions.

Here’s the scoop on new 2017 clinical laboratory test codes coming down the pike — based on our rundown of information presented at the CMS Annual Clinical Laboratory Public Meeting held July 18, 2016.

Despite the fact that the 2017 CPT^® codes aren’t finalized, CMS will determine the basis of payment for the new codes using comments from the meeting, according to CMS’s Glenn McGuirk, speaking at the event. You can access the proposed codes now, and the basis of payment when available later this fall, at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/Laboratory_Public_Meetings.html. 

We told you the buzz about new drug screen codes for 2017 last month in “Welcome Drug-Screen Code Update — Again” (Pathology/Lab Coding Alert Vol 17 no 10), but that’s not the only important change. Read on for a summary of what you need to know for lab coding and billing next year.

Prepare for New MAAA and GSP Codes

You’ll have just one new Tier 1 molecular diagnostics test code for 2017 — for Septin 9 methylation analysis for colorectal cancer.

But you’ll find four new Genomic Sequencing Procedure (GSP) codes next year, as tests using next generation sequencing continue to come on line. Look for specific codes for the following tests:

• Two new codes for cardiac ion channelopathies using a genomic sequence analysis panel, or a duplication/deletion gene analysis panel
• A new code for fetal chromosome microdeletions using GSP
• A new code for GSP analysis for inherited cardiomyopathy.

You’ll also see a new code for a Multianalyte Assay with Algorithmic Analysis (MAAA) for high-grade prostate cancer. The test includes a biochemical assay of total, free, and intact Prostate Specific Antigen (PSA), and human kallikrein-2 (hK2), with a prognostic algorithm.

Update Microbiology Coding Options

The CPT^® microbiology section has several existing codes for tests that aid in differential diagnosis of conditions such as respiratory or gastrointestinal infections — here are some examples:

• 87631-87633 — Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (e.g., adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus…), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes … (Each code indicates an increasing number of targets.)
• 87505-87507 — Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen (e.g., Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes,… (Each code indicates an increasing number of targets.)

Now CPT^® 2017 adds a similar code for a test that aids in the differential diagnosis of central nervous system pathogens, as follows:

• 87483 — Infectious agent detection by nucleic acid (DNA or RNA); central nervous system pathogen (e.g., Neisseria meningitidis, Streptococcus pneumoniae, Listeria, Haemophilus influenzae, E. coli, Streptococcus agalactiae, enterovirus, human parechovirus, herpes simplex virus type 1 and 2, human herpesvirus 6, cytomegalovirus, varicella zoster virus, Cryptococcus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12-25 targets.

“This test is a qualitative multiplexed nucleic acid-based in vitro test intended for simultaneous detection and identification of nucleic acids from multiple bacteria, viruses, and fungi directly from the central nervous system,” explained Robert Jerris, PhD, D (ABMM), director of clinical microbiology at Children’s Healthcare of Atlanta, representing the American Society for Microbiology at the public meeting.

That’s not all: At the public meeting, CMS also looked for pricing recommendations for two HCPCS Level II microbiology codes, as follows:

• G0475 — HIV antigen/antibody, combination assay, screening
• G0476 — Infectious agent detection by nucleic acid (DNA or RNA); human papillomavirus (HPV), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test.

CPT^® already provides comparable codes for these tests, but CMS created the “G” codes for situations when labs perform these tests for screening rather than diagnostic purposes. The parallel CPT^® codes are as follows:

• 87389 — Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result
• 87624 — Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68).

Notice that G0475 doesn’t specify the lab method like 87389 does, but specifies only that the test is for a combination assay for HIV antigen and antibody.

“Not specifying the method for this screening test is a good thing, because limiting the method has led to confusion in how to use some screening codes in the past,” says William Dettwyler, MT AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.