Pathology/Lab Coding Alert

Heads up for a new list of codes that Medicare says you can't report together without a modifier. NCCI's latest version (9.3) pairs different blood count components and different immunology procedures that weren't included in earlier versions. The edits are effective Oct. 1.
 
Some of the new edit pairs represent services that labs  would probably not perform together for the same patient on the same day, but you have to be aware of the changes in order to override the edit if you legitimately perform paired services together. "If you haven't looked at the NCCI edits , you may face some unexpected denials," says William Dettwyler, MT-AMT, coding analyst for Health Systems Concepts, a laboratory coding and compliance consulting firm in Longwood, Fla. "That's why billing departments and labs have to work together to stay current on NCCI edits."
 
If your lab carries out two services of a code pair as distinct and independent procedures that are medically necessary, Medicare may pay for the tests if you report them with the appropriate modifier. To indicate that codes represent separate services as opposed to unbundling a single service, append modifier -59 (Distinct procedural service) or -91 (Repeat clinical diagnostic laboratory test) for clinical lab tests conducted more than once a day. NCCI assigns every code pair a modifier indicator of either "1," which means a modifier can be used with the pair, or "0," which means a modifier cannot be used.
 
NCCI 9.3 added the lab code pairs in the table below: CMS bundles the codes in pairs as indicated in the table. The table also shows a modifier indicator for each edit pair.

For other edit pairs that may affect coding for your lab, see "Don't Let NCCI 9.3 Surgical Pathology Edits Stop You" on page 81 of this issue.