Pathology/Lab Coding Alert

Look ahead to immunology tests for auto-immune disorders.

The floodgate opened for new 2022 clinical laboratory test codes with the Clinical Laboratory Fee Schedule (CLFS) Annual Public Meeting held June 24, 2021.

Read on for our rundown of new code descriptors and possible pricing expectations that will impact your lab next year.

Notice: The American Medical Association (AMA) hasn’t finalized the 2022 CPT^® code numbers, but the Centers for Medicare and Medicaid Services (CMS) provides the code definitions for stakeholder comment. The open meeting is part of the process to determine the basis of payment for the codes, according to CMS’s meeting facilitator, Sarah Harding, from the CMS CLFS policy team.

Review 2021 SARS-Cov-2 Codes

Although you’re already familiar with lab codes for SARS-CoV-2 released last year, the 2021 annual public meeting provided the first opportunity for stakeholders to make pricing recommendations to establish national payment rates. Until that time, local Medicare Administrative Contractors (MACs) have been responsible for developing the payment amount for claims they receive for newly created HCPCS codes in their respective jurisdictions.

For a refresher on those SRS-CoV-2 codes, ranging from microbiology to immunology to Proprietary Laboratory Analyses (PLA) codes, see past issues of Pathology/Lab Coding Alert such as Vol. 21 No. 2, and Vol. 22 No. 3.

Anticipate New Immunology Test Codes

CPT^® 2022 will include the following new immunology codes (interim code numbers):

• 860XX (Aquaporin-4 (neuromyelitis optica [NMO]) antibody; enzyme-linked immunosorbent immunoassay (ELISA))
• 860X1 (… cell-based immunofluorescence assay (CBA), each)
• 860X2 (… flow cytometry (ie, fluorescence-activated cell sorting [FACS]), each)
• 863X2 (Myelin oligodendrocyte glycoprotein (MOG-IgG1) antibody; cell-based immunofluorescence assay (CBA), each)
• 863X3 (… flow cytometry (ie, fluorescence-activated cell sorting [FACS]), each)
• 862X0 (Endomysial antibody (EMA), each immunoglobulin (Ig) class)
• 862XX (Gliadin (deamidated) (DGP) antibody, each immunoglobulin (Ig) class)
• 862X1 (Tissue transglutaminase, each immunoglobulin (Ig) class)
• 863X4 (Mitochondrial antibody (eg, M2), each)
• 865X0 (Voltage-gated calcium channel antibody, each)
• 86XX0 (Actin (smooth muscle) antibody (ASMA), each)
• 86X00 (Antineutrophil cytoplasmic antibody (ANCA); screen, each antibody)
• 86X01 (… titer, each antibody)

Units: You’ll need to pay attention to the units described by these immunology codes when you start to use them next year. In some cases, you’ll report one unit of the code for each antibody, but in other cases you’ll bill one unit for each immunoglobulin antibody class.

“Codes 86X00 and 86X01 will be a welcome addition because reporting ANCA in addition to other leukocyte antibodies is difficult using 86021 (Antibody identification; leukocyte antibodies), which states ‘antibodies’ instead of ‘each antibody,” says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore. Because the new codes state, ‘each antibody,’ you’ll be able to report multiple units when the lab performs P-ANCA and C-ANCA antibody tests, which physicians frequently order together, he says.

Upgrade MAAA and PLA Codes

You’ll find new Multianalyte Assays with Algorithmic Analysis (MAAA) codes next year, two that are Category I codes and two administrative codes, as follows:

• 815X0 (Transplantation medicine (allograft rejection, pediatric liver and small bowel), measurement of donor and third-party-induced CD154+T-cytotoxic memory cells, utilizing whole peripheral blood, algorithm reported as a rejection risk score)
• 002XM (Transplantation medicine (allograft rejection, renal), measurement of donor and third-party-induced CD154+T-cytotoxic memory cells, utilizing whole peripheral blood, algorithm reported as a rejection risk score)
• 0017M (Oncology (diffuse large B-cell lymphoma [DLBCL]), mRNA, gene expression profiling by fluorescent probe hybridization of 20 genes, formalin-fixed paraffin-embedded tissue, algorithm reported as cell of origin)
• 815X1 (Oncology (breast), mRNA, next-generation sequencing gene expression profiling of 70 content genes and 31 housekeeping genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as index related to risk to distant metastasis)

Inclusive: Remember that MAAA codes represent the work of performing all technical lab test(s), gathering relevant patient data, carrying out an algorithmic analysis, and reporting the results as a risk or probability score.

PLA: CPT^® 2022 will also include more than 55 new PLA codes in addition to those for SARS-CoV-2 testing. Because the AMA releases new PLA codes each quarter, you may already know about many of these codes, but 2022 is the first time the codes will appear in the manual. The PLA codes may include MAAA procedures, drug assays, hematology tests, and molecular pathology tests for cancer or constitutional disorder, among others.

Each PLA code applies to one unique lab test performed by a specific (proprietary) lab or made by a specific manufacturer. You should use the PLA code only for the specific proprietary test, and you should not use any other code (such as Category I) to describe the test if a PLA code is available.

Know Appendix O: CPT^® provides Appendix O to list all MAAA tests, including Category I codes that you’ll find in the Pathology and Laboratory chapter, administrative codes (four digits followed by the letter “M”) that aren’t assigned a Category I or PLA code. The appendix also lists all PLA codes, whether or not the code describes a MAAA test.

Greet New Chemistry Tests and More

The annual laboratory public meeting also provided an opportunity for stakeholders to make pricing recommendations for the following tests in various CPT^® sections:

Chemistry:

• 835X1 (Interleukin-6 (IL-6))
• 8352X (Immunoglobulin light chains (ie, kappa, lambda), free, each)
• 826X0 (Elastase, pancreatic (EL-1), fecal; quantitative)

Therapeutic Drug Assay

• 801XX (Hydroxychloroquine)

Microbiology

• 8715X (Culture, typing; identification of blood pathogen and resistance typing, when performed, by nucleic acid (DNA or RNA) probe, multiplexed amplified probe technique including multiplex reverse transcription, when performed, per culture or isolate, 6 or more targets)

Molecular Pathology

• 812X0 (Cytogenomic (genome-wide) analysis for constitutional chromosomal abnormalities; interrogation of genomic regions for copy number and loss-of-heterozygosity variants, low-pass sequencing analysis)
• G0327 (Colorectal cancer screening; blood-based biomarker)

Look to future issues of Pathology/Lab Coding Alert for updates on CMS pricing decisions and details about the clinical impact of some of these codes.