Pathology/Lab Coding Alert

pathology Coder need to be aware of the significant changes in the microbiology section of CPT 2001 to gain appropriate reimbursement. In updating the codes to more accurately reflect current practice and coding conventions, 32 new codes and 41 revisions were added, while 16 existing codes were deleted, says Laurie Castillo, MA, CPC, CPC-H, CCS-P, member of the National Advisory Board of the American Academy of Professional Coders (AAPC) and president of its northern Virginia chapter. More than ever, it is imperative that laboratory coders get the updated version of the CPT Codes and familiarize themselves with the changes.

A significant addition to the section involves the clarification of presumptive versus definitive identification of organisms, explains William Dettwyler, MT-AMT, coding analyst for Health Systems Concepts, laboratory coding and compliance consultants in Longwood, Fla. New language in the introduction to the microbiology section defines presumptive identification of microorganisms as identification by colony morphology, growth on selective media, gram stains or up to three tests (e.g., catalase, oxidase, indole, urease). Definitive identification is defined as identification to the genus or species level that requires additional tests (e.g., biochemical panels, slide cultures). Many of the code revisions and additions clarify whether that specific test is for presumptive or definitive identification. The key to using these codes for appropriate reimbursement lies in understanding that if a test for presumptive identification is followed by a definitive test, both codes should be reported, Dettwyler says. If additional identification tests are conducted to more specifically type isolates, the appropriate code(s) 87140-87158 should be reported as well.

Presumptive Codes

For example, revised code 87101 (culture, fungi [mold or yeast] isolation, with presumptive identification of isolates; skin, hair, or nail) would be used to determine whether a fungal organism is present. If a followup test is conducted to specifically identify the organism, coders would additionally report either revised code 87106 (culture, fungi, definitive identification, each organism; yeast) or new code 87107 (culture, fungi, definitive identification, each organism; mold). Bacterial throat or nose cultures should now be reported using 87070 (culture, bacterial; any other source except urine, blood or stool, with isolation and presumptive identification of isolates) or 87081 rather than the deleted code 87060.

In codes 87071 (... quantitative, aerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool) and 87073 (... quantitative, anaerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool) different culture sets are required for anaerobes and aerobes. If both are performed, report both 87071 and 87073.

Use 87081 (culture, presumptive, pathogenic organisms, screening only) in place of deleted codes 87082, 87083 and sometimes 87060. Code 87088 (culture, bacterial; with isolation and presumptive identification of isolates, urine) reports commercial kits that were formerly billed with deleted code 87087.

Definitive Codes

Definitive codes may be reported in addition to an original presumptive test. Codes 87076 (culture, bacterial; anaerobic isolate, additional methods required for definitive identification, each isolate) and 87077 (... aerobic isolate, additional methods required for definitive identification, each isolate) replace deleted codes 87072 and 87163. Code 87118 (culture, mycobacterial, definitive identification, each isolate) was revised to be used for each isolate rather than each organism.

Additional Identification Tests

Additional identification tests for typing of isolates may be reported in addition to presumptive and/or definitive tests. Code 87140 (culture, typing; immunofluorescent method, each antiserum) was revised to update fluorescent terminology, and 87143 (... gas liquid chromatography (GLC) or high-pressure liquid chromatography (HPLC) method) was revised to add HPLC. Codes 87151 and 87155 have been deleted and should be reported using 87149 (... identification by nucleic acid probe) and 87152 (culture, typing: identification by pulse field gel typing). Code 87145, for the older phage method, has been deleted.

Any type of concentration methodology for infectious agents should be reported in addition to the identification methodology using revised code 87015 (concentration [any type], for infectious agents), unless concentration is inherent in the identification test (such as 87177, ova and parasites, direct smears, concentration and identification).

Code 87117 was deleted to avoid duplicate codes for the same procedure.

New Codes Added for Common Tests

Many microbiology codes have been added to CPT this year for tests that have become common enough to warrant a separate number, Castillo says. Previously these procedures would have been reported using one of the general methodology codes. Coders need to be certain to pick up these changes, and update any in-house code sheets they may use so that they dont continue to use the generic codes when a more specific code exists. These changes include:

Code 87045 has been modified to specify isolation and preliminary examination (e.g., KIA, LIA), Salmonella and Shigella species. Code 87046 (culture, bacterial; stool, additional pathogens, isolation and preliminary examination [e.g., Campylobacter, Yersinia, Vibrio, E. coli 0157], each plate) should now be used to report the special plating of additional pathogens. Previously, 87045 would have been used to report any bacterial stool culture.

Codes were added for common infestations:

87168 macroscopic examination; arthropod
87169 parasite
87172 pinworm exam (e.g., cellophane tape prep)

Codes for specific common pathogens were added under Infectious agent antigen detection by immunofluorescent technique:

87273 herpes simplex virus type 2 (87274 was revised to specify type 1)
87275 influenza B virus
87277 legionella micdadei
87279 parainfluenza virus, each type
87281 pneumocystis carinii
87283 rubeola

Code 87300 (infectious agent antigen detection by immunofluorescent technique, polyvalent for multiple organisms, each polyvalent antiserum) was added for infectious agent antigen screening. This code represents one test that can screen for a number of organisms, and is to be reported once per screening, not per organism, Dettwyler says. The code is followed by a new note to direct the user to the physician evaluation code 88346, for immunofluorescent tissue studies. Most coders are already aware that 88346 is the appropriate code to describe anatomic pathology tissue studies for infectious agents.

Codes for specific common pathogens were added under infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method:

87327 cryptococcus neoformans
87336 entamoeba histolytica dispar group
87337 entamoeba histolytica group
87339 helicobacter pylori
87341 hepatitis B surface antigen (HBsAg) neutralization
87400 influenza, A or B, each
87427 shiga-like toxin

Codes were added for genotype and phenotype assays for HIV drug resistance. These tests are becoming more common to help physicians choose appropriate treatments by avoiding drugs to which the patients particular virus is no longer sensitive.

87901 infectious agent genotype analysis by nucleic acid (DNA or RNA), HIV 1, reverse transcriptase and protease

Two codes were added for infectious agent genotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis, HIV 1. Report code 87903 (... up to 10 drugs) one time for assaying up to 10 drugs. There is some ambiguity regarding +87094 (each additional drug, up to 5 drugs [list separately in addition to code for primary procedure]), which reportedly will be changed next year to clarify the wording. Evidently the intent of the code is to report each additional one to five drugs after the first 10 reported using 87903. Contact your insurer for correct use of this code.

Reporting for Each Organism

Several microbiology codes were revised this year to clarify that the code should be reported once for each organism, Dettwyler says. Awareness of how to use these codes is imperative for full reimbursement when multiple organisms are identified. If these tests are repeated more than once in a day for the same patient for different organisms, the code should be reported with multiple units. Although most payers will accept multiples of these tests, some may require the use of a modifier, such as -59 (distinct procedural service), to indicate that the subsequent tests represent a separately identifiable procedure carried out to identify a different organism. These codes include:

87299 infectious agent antigen detection by immunofluorescent technique; not otherwise specified, each organism.

87449 infectious agent antigen detection by enzyme immunoassay technique qualitative or semiquantitative; multiple step method, not otherwise specified, each organism.

87450 ... single step method, not otherwise specified, each organism

87451 ... multiple step method, polyvalent for multiple organisms, each polyvalent antiserum (new code)

87797 infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; direct probe technique, each organism

87798 ... amplified probe technique, each organism

87799 ... quantification, each organism

The revisions to 87797-87799 also distinguish them from new codes for mixed infectious agent analyses using mixed probe processes: 87800 (infectious agent detection by nucleic acid [DNA or RNA], multiple organisms; direct probe[s] technique) and 87801 (... amplified probe[s] technique).

Updated Codes for Clarification and Terminology

Several of the microbiology code revisions were made to reflect current terminology or to clarify confusion over wording. Many of these changes are self-explanatory, but some, which could bear elucidation, are listed below:

Code 87086 (culture, bacterial; quantitative colony count, urine) was modified to consolidate with redundant code 87085, which was deleted.

Code 87176 (homogenization, tissue, for culture) is no longer an indented code, as the parent and sister codes 87174 and 87175 have been deleted.

Codes 87181-87190 were modified to refer to susceptibility studies, antimicrobial agent, rather than sensitivity studies. The codes were further modified to distinguish methods for the susceptibility tests. Under these new definitions, redundant code 87192 was deleted, and 87185 (enzyme detection [e.g., beta lactamase], per enzyme) was added. The wording was also broadened, for example, changing per antibiotic to per agent to make the codes more accurate across all applications, Dettwyler explains. Also, +87187 (susceptibility studies, antimicrobial agent; multidilution or agar dilution, minimum lethal concentration (MIC), each plate [list separately in addition to code for primary procedure]) is now clarified as an add-on code by addition of the +, and both the wording in the code definition and the note below the code indicate that this service is to be reported in addition to the primary procedure (87186 or 87188).

Code 87205 (smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types) has new wording, which eliminates the confusion over the old wording routine stain, and clarifies the type of stain involved in this service. Minor changes were also made to the other three codes in this family, 87206 (smear, primary source with interpretation; fluorescent and/or acid fast stain for bacteria, fungi, parasites, viruses or cell types), 87207 (... special stain for inclusion bodies or intracellular parasites [e.g., malaria, coccidia, microsporidia, cytomegalovirus, herpes viruses]) and 87210 (... wet mount for infectious agents [e.g., saline, India ink, KOH preps]) to clarify types of stains. Code 87220 was also modified to clarify sample source, and a note added to distinguish it from code 87210.

In codes 87250 (virus isolation; inoculation of embryonated eggs, or small animal, includes observation and dissection), 87252 (... tissue culture inoculation, observation, and presumptive identification by cytopathic effect) and 87253 (... tissue culture, additional studies or definitive identification [e.g., hemabsorption, neutralization, immunofluorescence stain], each isolate) wording was changed from virus identification to virus isolation to correct misleading terminology. Also, 87252 was clarified as presumptive identification, while 87253 was clarified to include additional studies or definitive identification, each isolate. A new code was also added to this family 87254 (virus isolation; shell vial, includes identification with immunofluorescence stain, each virus).

The introduction to the infectious agent detection codes (87260-87904) clarifies that these codes are intended for primary source only. For similar studies on culture material, refer to codes 87140-87158.