Pathology/Lab Coding Alert

CPT 2002 contains several changes for pathology/laboratory coding . The section includes 11 new, 15 revised and six deleted codes, as well as some changes to the narrative instructions. The modified codes go into effect Jan. 1, 2002, for Medicare, although some carriers and third-party payers may take longer to implement them. "Although some insurers allow a three-month grace period before requiring their use, coders should not wait until April 1 to learn how to use these codes," says Laurie Castillo, MA, CPC, CPC-H, CCS-P, member National Advisory Board of the American Academy of Professional Coders and president of Physician Coding and Compliance Consulting in Virginia.

Codes Moved for Consistency

"Probably one of the biggest changes for anatomic pathology involves removing four codes from pathology and placing them in the surgery section of CPT," reports R.M. Stainton, MD, president of Doctor's Anatomic Pathology in Jonesboro, Ark. The services involve bone marrow aspiration or biopsy and fine needle aspiration (FNA).
 
Although the codes have been moved to the surgery section, pathologists will still report these services, using the new codes, if they perform the procedure. In the introductory "Instructions for Use of CPT," the AMA states: "It is important to recognize that the listing of a service or procedure and its code number in a specific section of this book does not restrict its use to a specific specialty group. Any procedure or service in any section may be used to designate the services rendered by any qualified physician or healthcare professional."
 
"The reason these services were moved to the surgery section is that they were more consistent with surgical procedure, whether it is conducted by a surgeon, pathologist or radiologist. The interpretation of the aspirate or biopsy is still reported with the appropriate code from the pathology section," Stainton says.
 
The following code deletions, additions and changes involve the new codes for FNA and bone marrow sampling. The new codes and their definitions appear in bold type:
 

85095 has been deleted. To report, use 38220.

38220 bone marrow aspiration. This code has a similar definition as deleted code 85095, which read bone marrow; aspiration only.

The text of the following two notes were changed to include 38220:
 

85100 has been deleted. To report, use 38220 and 85097.

85101 has been deleted. For aspiration, use 38220.

Other revised changes to bone marrow codes include the following:
 

85097 bone marrow, smear interpretation. This code is revised from the old definition, which read bone marrow; smear interpretation only, with or without differential cell count.

85102 has been deleted. To report, use 38221.

38221 bone marrow biopsy, needle or trocar. This code has the same wording as deleted 85102.

A separate code deletion has changed how iron stain for bone marrow smears is reported:
 

85535 has been deleted. To report, use 85536. Old code 85535 reported iron stain (RBC or bone marrow smears). To avoid redundancy, this service is now reported using 85536 (iron stain, peripheral blood), which has not changed.

Changes to FNA codes are as follows:
 

88170 has been deleted. To report, use 10021.

10021 fine needle aspiration; without imaging guidance. This code has a definition similar to deleted code 88170, which read fine needle aspiration; superficial tissue (e.g., thyroid, breast, prostate).
 

88171 has been deleted. To report, use 10022.

10022 fine needle aspiration; with imaging guidance. This code has a definition similar to deleted code 88171, which read fine needle aspiration; deep tissue under radiologic guidance. A note was added to the surgical pathology section under 88309 to direct coders to 10021 or 10022 for FNA, and 88172-88173 for evaluation of FNA.

Occult Blood Tests Wording Changes

The coding for occult blood tests is modified slightly in CPT 2002 with the wording of two code definitions changed.
 

82270 blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, 1-3 simultaneous determinations. This code is the same as last year except the term "qualitative" was added to the definition, preceding the semicolon.

82273 blood, occult, by peroxidase activity (e.g., guaiac), qualitative; other sources. Because "qualitative" was added to the portion of the text that precedes the semicolon, it was deleted from the latter part of the code this year. The definition of the code does not change.

82274 blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations. This code replaces 86683 hemoglobin, fecal, which has been deleted. Code 86683 was new in CPT 2001, and it was noted at the time that the code had been placed in the wrong section and would be moved to chemistry in 2002. Note that the comment under 83036, which directs coders to the test for fecal hemoglobin detection by immunoassay, has been changed to refer to 82274 rather than 86683.
 
"In the final analysis, this code structure allows reporting fecal occult blood tests by two different qualitative methods, 82270 for guaiac and 82274 for immunoassay. Either code would be reported once for one, two or three determinations," says Kenneth Wolfgang MT (ASCP), CPC, CPC-H, member of the National Advisory Board of the American Academy of Professional Coders and director of coding and analysis, National Health Systems Inc., a coding consultation company in Camp Hill, Pa. Code 82273 reports occult blood test by peroxidase activity for any source other than feces.

Category III Codes Added

CPT 2002 added a new section of Category III codes, which are temporary codes that describe emerging technology, services and procedures. These codes allow for data collection about these services, which may not be widely practiced or FDA-approved as are Category I codes. CPT instruction states, "If a Category III code is available, this code must be reported instead of a Category I unlisted code." However, Castillo reminds coders to await confirmation that insurers will accept the

Category III codes before using them.
 
The Category III codes may eventually receive a Category I code. There are three new Category III codes this year.
 

0010T tuberculosis test, cell mediated immunity measurement of gamma interferon antigen response. A note at the beginning of the immunology section, and following 86585 (skin test; tuberculosis, tine test), points out this code for tuberculosis testing.

0023T infectious agent drug susceptibility phenotype prediction using genotypic comparison to known genotypic/phenotypic database, HIV 1. A note following 87901 (infectious agent genotype analysis by nucleic acid [DNA or RNA]; HIV-1, reverse transcriptase and protease) mentions this code for HIV 1 drug susceptibility testing.

0026T lipoprotein, direct measurement, intermediate density lipoproteins (IDL) (remnant lipoproteins). Following 83721 (lipoprotein, direct measurement; LDL cholesterol), the CPT text notes to report 0026T for intermediate density lipoproteins.

New Codes Added to Microbiology, Immunology

A note was added to the introductory comments for 87260-87999, which describe tests for infectious agent antigen detection from a primary source (not culture). The direction states, "When separate assays are performed for different species or strain(s) of organisms, each assay should be reported separately."
 
Within this portion of the microbiology section, a group of codes was added to report specific antigen detection by direct optical observation of immunoassay results. The codes use the same method for three specific organisms:
 

87802 infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group B

87803 clostridium difficile toxin A

87804 influenza.

"These tests are similar in methodology to existing tests for Chlamydia trachomatis (87810), Neisseria gonorrhoeae (87850) and Streptococcus, group A (87880) in that the test results are read by an optical observation such as a simple color change," Wolfgang says. 
 
A new Hepatitis C code was also added to the existing code family describing genotype analysis methods. Identification of Hepatitis C genotype is crucial to determining appropriate treatment.
 

87902 infectious agent genotype analysis by nucleic acid (DNA or RNA); Hepatitis C virus.

Elsewhere in the microbiology section, two codes were added for specific, direct fluorescent antibody tests. These tests allow the detection of antigens in primary source material or cultures.
 

87198 cytomegalovirus, direct fluorescent antibody (DFA).

87199 enterovirus, direct fluorescent antibody (DFA).

Two codes were added to the immunology section for procedures that did not previously have a code:
 

86141 C-reactive protein; high sensitivity (hsCR). 
"This is a relatively new blood test that was reported to be twice as effective as a standard cholesterol test in predicting heart attacks and strokes, based on a study reported in the New England Journal of Medicine," Wolfgang says.
 

86336 inhibin A.
"This test is useful in the evaluation of infertility disorders and the detection of Down's syndrome in utero," Wolfgang says.

Other codes in pathology include:
 

88380 microdissection (e.g., mechanical, laser capture). This code describes a method for obtaining desired cells from microscopic tissue sections for further study, such as genotyping or protein analysis. A cross-reference for this code was added to the cytogenetic studies section.
 

83950 oncoprotein, HER-2/neu. "This serum test is useful in breast cancer diagnosis, and is used to qualify patients for Herceptin therapy," Wolfgang says.
 
A note following 83950 notes, "for tissue, see 88342, 88365." A separate note was added under 86304 (immunoassay for tumor antigen, quantitative; CA 125) pointing out 83950.

Terminology Changes

A few minor changes in 2002 entail updating terminology. For example, the term "immunoglobulin" is changed in the following codes:
 

84445 thyroid stimulating immune globulins (TSI)

83916 oligoclonal immune (oligoclonal bands).

 The term "small bowel" was changed to "small intestine" in the following codes:
 

88304 level III - surgical pathology, gross and microscopic examination, diverticulum - esophagus/ small intestine

88305 level IV - surgical pathology, gross and microscopic examination, polyp, stomach/small intestine.

 The term "CFS" was changed to "cerebrospinal fluid" in the following codes:
 

89050 cell count, miscellaneous body fluids (e.g., cerebrospinal fluid, joint fluid), except blood

86325 immunoelectrophoresis; other fluids (e.g., urine, cerebrospinal fluid) with concentration.

The term "stool" was replaced with the term "feces" in one code:
 

87045 culture, bacterial; feces, with isolation and preliminary examination (e.g., KIA, LIA) Salmonella and Shigella species.

 The word "stone" was removed as a parenthetic description following the word "calculus" in the following code:
 

82355 calculus; qualitative analysis.

Other Changes Clarify Procedure, Reporting

Both 87903 and 87904 were changed to clarify the number of individual tests included for each service. The two codes were new in CPT 2001, and 87903 designated that the test was for "up to 10 drugs." Code 87904 designated "each additional drug, up to five drugs." The wording was clarified in CPT 2002 to indicate that 87903 should be reported once for one through 10 drugs tested. If more than 10 drugs are tested, 87904 should also be reported, once for each additional one through five drugs. If more than 15 but less then 21 drugs are tested, 87903 would be reported once and 87904 would be reported twice.
 

87903 infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; first through 10 drugs tested

87904 each additional 1 through 5 drugs tested (list separately in addition to code for primary procedure).
 
Other changes include:

83013 helicobacter pylori; analysis for urease activity, non-radioactive isotope was changed from "(mass spectrometry)" to "non-radioactive isotope." The new wording includes mass spectrometry, but allows for other non-radioactive isotope methods as well such as laser-assisted ratio analysis.
 

80072 arthritis panel has been deleted. If the tests that comprised the arthritis panel are carried out, report each individually. These are 84550, 85651, 86255 and 86430.