Pathology/Lab Coding Alert

Code the most extensive service to recoup all of your pay

Semen analysis codes 89300-89321 include a check for sperm presence and motility, according to National Correct Coding Initiative (NCCI) edits. That means you can expect to see your claims denied if you report 89300-89321 with G0027 (Semen analysis; presence and/or motility of sperm excluding Huhner). NCCI version 10.1 adds these edit pairs, which took effect April 1.

CMS reinstated G0027 on Jan. 1 after earlier deleting the code and instructing coders to use 89310 (Semen analysis; motility and count [not including Huhner test]) instead. Now that G0027 is back, CMS clarifies that you should report the code when the lab performs a stand-alone sperm presence and motility check for a Medicare beneficiary, not when the check is part of a more extensive service.

Know When You Can't Use Modifier -59

NCCI 10.1 bundles the following codes with G0027 (See Chart)

"Bundling G0027 with the CPT semen analysis codes makes sense, because when the lab performs any of the 89300-89321 services, the test includes an evaluation for sperm presence and/or motility," says Melanie Witt, RN, CPC, MA, an independent coding consulting in Fredericksburg, Va.

Because G0027 and CPT 89321 both describe Semen analysis; presence and/or motility of sperm, NCCI 10.1 lists these as a mutually exclusive code pair. NCCI also states that other semen analysis codes 89300, 89310 and 89320 are "most extensive procedures" that include the service described by code G0027.

Warning: A modifier indicator of "0" for all of these code pairs means that you cannot report the codes together for the same patient on the same day under any circumstances, and modifier -59 (Distinct procedural service) will not override the edits.

Pathologist Does Not Interpret Semen Analysis

Because the ordering physician interprets the semen analysis lab results using additional patient history and examination information, the pathologist does not usually provide a semen test interpretation. Therefore, NCCI prohibits reporting semen analysis with clinical laboratory pathology consultation codes 80500 or 80502.

By listing these code pairs with modifier indicator "1," NCCI allows you to report a consultation (80500 or 80502) with one of the semen analysis codes, when necessary, using modifier -59. "To override the edit pairs, you must meet all the requirements for a consultation," says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Tip: You can only report a consultation if the service meets the "Three R's":