Pathology/Lab Coding Alert

Catch new code for DHT, too.

If your lab sometimes performs direct-measure tests for lipoprotein fractions, expect a new code in your reporting toolbox beginning Jan. 1: 83722 (Lipoprotein, direct measurement; small dense LDL cholesterol).

Don’t confuse this new, direct-measure test with existing CPT^® codes, like those for lipoprotein separation and quantitation. Read on to learn our expert’s advice on using 83722 and other new CPT^® 2019 chemistry codes.

Clinical significance: Although low-density lipoprotein (LDL) is known to play a significant role in atherosclerosis and cardiovascular disease, newer studies indicate that a key LDL subfraction — small dense (sd)LDL — is the key component in progression of these disease processes.

The sdLDL test may help identify patients with hereditary high LDL or LPA lipoprotein(a) deficiency, explains Julie-Leah J. Harding, CPC, CPMA, CEMC, CCC, CRC, CPEDC, RMC, PCA, CCP, SCP-ED, CDIS, and AHIMA-approved ICD-10 trainer, ambassador and director of revenue operations at Boston Children’s Hospital in Boston, Massachusetts. Patients with this hereditary condition are at severe cardiac and stroke risk, according to Harding.

Join Direct Measure Family

CPT^® 2019 adds new-code 83722 under parent-code 83718 (Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)). “Other codes in the family describe direct measurement of very-low-density lipoprotein (VLDL cholesterol, 83719) and low-density lipoprotein (LDL cholesterol, 83721),” says William Dettwyler, MT AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Know methods: Lab procedures for these direct-measure tests typically include an initial step using a reagent such as a surfactant or ionic polymer to make certain lipoprotein fractions in the specimen either resistant or receptive to a reagent used in the next step. The second part of these direct-measurement tests typically involves binding the desired lipoprotein fraction with an enzyme or other chemical marker that yields a reaction measurable by a chemistry analyzer, such as a colorimetric change.

Distinguish 83700-83704 Codes

Labs sometimes use other, more complex methods to quantify cholesterol fractions. These procedures require physical separation of the lipoprotein classes using methods such as precipitation, ultracentrifugation, or electrophoresis. Some procedures also involve quantitation using methods such as nuclear magnetic resonance spectroscopy. Almost all these tests provide results for multiple lipoprotein fractions in a specimen.

If your lab uses one of these methods for multiple lipoprotein fractions, you should turn to codes in the range 83700-83704 (Lipoprotein, blood …) instead of using the direct-measure codes for specific fractions in the range 83718-83722.

Prepare for 82642

Code 83722 is one of two new CPT^® 2019 codes in the Chemistry section. The other is 82642 (Dihydrotestosterone (DHT)).

Clinical significance: Clinicians may order DHT testing for prostate cancer patients undergoing 5 alpha-reductase inhibitor therapy or chemotherapy. The enzyme 5 alpha-reductase normally reduces testosterone to produce DHT, so clinicians may need to monitor DHT serum levels for patients undergoing certain prostate cancer treatments.

Lab methods to test DHT levels in a patient specimen, such as serum, include liquid chromatography and tandem mass spectrometry (LC-MS/MS) to isolate and quantify DHT levels.

Until 82642 becomes effective on Jan. 1, labs should continue to report the test as they always have, typically using a non-specific code such as 80327 (Anabolic steroids; 1 or 2).