Pathology/Lab Coding Alert

Look for novel RSV and Zika test codes, too.

If you want the scoop on new 2018 clinical laboratory test codes coming down the pike, look no further. Based on our rundown of information presented at the CMS Annual Clinical Laboratory Public Meeting held July 31, 2017, we'll give you a sneak peek.

Caveat: The 2018 CPT® codes aren't finalized, but 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.

Expand Human Platelet Antigen Genotyping and More

With 31 new molecular pathology codes anticipated for 2018, you'll have a steep learning curve if your lab performs any of these services. The following table gives you an overview of the major additions to these codes:

Table 1: New 2018 Molecular Pathology Codes

Prepare for New MAAA and GSP Codes

You'll find one new Genomic Sequencing Procedure (GSP) code proposed for 2018, and that's 814X5 (Hereditary peripheral neuropathies panel [eg, Charcot-Marie-Tooth, spastic paraplegia], genomic sequence analysis panel, must include sequencing of at least 5 peripheral neuropathy-related genes [eg, BSCL2, GJB1, MFN2, MPZ, REEP1, SPAST, SPG11, and SPTLC1]).

Also prepare for four new Multianalyte Assay with Algorithmic Analysis (MAAA) codes next year, as follows:

• Two codes (815XX and 815X2) for breast cancer mRNA gene expression using formalin-fixed paraffin-embedded tissue; one test reports a recurrence risk score, one test reports an index related to risk of distant metastasis
• Two codes (81X41 and 815X1) for prostate cancer using formalin-fixed paraffin-embedded tissue; one test reports a disease-specific mortality risk score, one test reports the likelihood of prostate cancer detection on repeat biopsy

Update Microbiology and Immunology Coding Options

The Annual Clinical Laboratory Public Meeting also gave a preview of two new microbiology codes for RSV and Zika virus, as follows:

• 876XX (Infectious agent detection by nucleic acid [DNA or RNA]; respiratory syncytial virus, amplified probe technique)
• 87X6X (Infectious agent detection by nucleic acid [DNA or RNA]; Zika virus, amplified probe technique)

Additionally, you can expect new immunology codes in 2018, such as 87X6X, Zika virus, IgM).

A new code that represents a refined method for allergen testing is 8600X (Allergen specific IgE; quantitative or semiquantitative, recombinant or purified component, each).

Many allergen tests, such as skin tests, have traditionally used crude whole allergen extracts to detect sensitization, according to Brian Yang, MS, speaking on behalf of Thermo Fisher Scientific at the July 31 public meeting. "Today, we have much more evolved in vitro-test methods in component resolved diagnostics that have significantly higher specificity," Yang explained in reference to code 8600X.

Watch for PLA Codes

CPT^® 2018 will include a new section listing codes for Proprietary Laboratory Analyses (PLA). These are alpha-numeric codes assigned with approval by the AMA CPT^® Editorial Panel for unique lab tests that a specific clinical laboratory or test manufacturer produces or provides. The lab or manufacturer may apply for a code, with new codes released quarterly.

PLAs may be Advanced Diagnostic Laboratory Tests (ADLTs) or Clinical Diagnostic Laboratory Tests (CDLTs) as defined under the Protecting Access to Medicare Act of 2014 (PAMA). Many of the tests may be for MAAAs or GSPs, but the PLA codes may include other types of medical laboratory tests.

At the July 31, public meeting, CMS heard stake-holder comments about pricing for 17 currently-approved PLA codes (0001U-0017U) for tests ranging from oncology MAAAs (for breast, ovarian, and colorectal cancers) to drug test monitoring, to various infectious disease analyses.

To read more about PLAs and view a current list of AMA approved codes, visit www.ama-assn.org/practice-management/cpt-pla-codes.