Pathology/Lab Coding Alert

If you don't have a pathologist supervising your molecular array testing, you could stand to lose about $100.

That's because the CPT definition of 88384-88386, for "array-based evaluation of multiple molecular probes," requires a pathologist's involvement in the procedure, from beginning to end. Many facilities have a PhD supervise these procedures instead, and a PhD is only eligible to bill for the codes- technical component, which pay $319 for 88385 and $312 for 88386. The PhD cannot bill for the physician service, which pays $80 for 88385 and $100 for 88386. Code 88384 is carrier-priced.

Document pathologist involvement: Your pathologist must do more than just interpret the tests- results, says Diana Voorhees, MA, CLS, MT(ASCP)SH, CLCP, principal with DV and Associates Inc. in Salt Lake City. The pathologist must review any patient information or slides to decide on gene dosage and whether to continue with the testing.

The pathologist should also review controls to make sure results are valid -- and verify those results. If your pathologist doesn't perform these services, you shouldn't bill the professional fee for the array.

Do this: If separate billing entities provide the technical and professional portions of the array service, you should list the code with the appropriate modifier -- TC (Technical component) or 26 (Professional component). Billing an array code without a modifier represents the global service -- both the technical and professional components.

Look for non-surgical uses: You can use the codes for serum testing and other areas, as long as your pathologist is involved and employs molecular probes using array-based technology, Voorhees says. The codes are in the surgical pathology section because pathologists often use the tests on surgical specimens for tumor analysis, but they-re not limited to surgical pathology. "There are all kinds of applicability for array testing," she adds.

But there are limits, Voorhees says. If you use array-based probes that CPT specifically lists in the microbiology chapter's infectious disease section, you have to use those codes instead, she says.

Note: Calculated payment rates use the 2007 transitional nonfacility total with the 37.8975 conversion factor from the 2007 Medicare Physician Fee Schedule.