Pathology/Lab Coding Alert

Some relevant PLA codes are already effective.

In just two short months, you’ll be using new CPT^® 2023 codes to report unique lab tests for infectious agent detection, so tune in now to get ready for accurate claims next year.

Timeline: Although CPT^® 2023 code changes go into effect Jan. 1, 2023, some proprietary laboratory analyses (PLA) codes for infectious agent identification became effective in earlier quarters of 2022.

Introducing Specific Infectious Agent Codes

You’ll have the following five new Category I codes for infectious agent detection in CPT^® 2023:

• 87468 (Infectious agent detection by nucleic acid (DNA or RNA); Anaplasma phagocy­tophilum, amplified probe technique)
• 87469 (… Babesia microti, amplified probe technique)
• 87478 (… Borrelia miyamotoi, amplified probe technique)
• 87484 (… Ehrlichia chaffeensis, amplified probe technique)
• 87467 (Hepatitis B surface antigen (HBsAg), quantitative)

Replace NOS code: Codes 87468, 87469, 87478, and 87484 address tests for organisms that cause tickborne diseases. The test method involves testing a blood specimen to detect DNA fragments specific to the infecting organism using amplified probe technique. In each case, labs that currently run one of these tests report the service with 87798 (Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism). That stops on January 1 when you have a new, specific code for each organism.

Anaplasmosis (87468): This is a disease caused by the bacterium, Anaplasma phagocytophilum, which is transmitted to a person through a tick bite (specifically blacklegged tick, Ixodes scapularis, or in the west, Ixodes pacificus). The symptoms include muscle and head aches, fever, and chills, but can advance to organ failure and death. Common treatment is early intervention with the antibiotic doxycycline.

HME (87484): Human monocytic ehrlichiosis (HME) is a disease caused by the bacterium Ehrlichia chaffeensis, transmitted by an infected lone star tick (Amblyomma americanum) through a bite. Early symptoms may be mild, including fatigue, fever, head and body aches, and possibly vomiting and rash, but may progress to a severe case involving meningitis, acute respiratory distress syndrome (ARDS), or multisystem shock symptoms and death. Recommended treatment is early doxycycline dosing.

TBRF (87478): The bacterium Borrelia miyamotoi causes an illness similar to tickborne relapsing fever (TBRF) and is closely related to the causative Borrelia species. Transmitted in the bite of an infected tick (Ixodes scapularis or Ixodes pacificus), infection with B. miyamotoi may cause fatigue and aches, as well as repeating episodes of high fever. Recommended treatment is an early course of the antibiotic doxycycline.

Babesiosis (87469): A microscopic parasite called Babesia microti is transmitted by the bite of infected ticks (Ixodes scapularis and Ixodes pacificus) and causes the disease called babesiosis. The tick transmits the parasite between two hosts — a rodent, such as white footed mice, and humans — where it reproduces in host blood cells. Blood transfusions from an infected human is another mode of transmission. Babesiosis may be asymptomatic or include mild flu-like symptoms, but the illness can be severe in older or immunocompromised patients. For severe cases, clinicians may prescribe a combination of drugs such as clindamycin and quinine.

HBsAg: You’ll find new microbiology code 87467 for quantitative Hepatitis B surface antigen (HBsAg) testing. Prior to January 1, labs may have reported the test using the generic method code 82397 (Chemiluminescent assay).

Clinicians may order the test for patients with a confirmed diagnosis of hepatitis B virus (HBV) infection based on other tests, such as those described by existing codes 87340 (Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; hepatitis B surface antigen (HBsAg)), 87341 (… hepatitis B surface antigen (HBsAg) neutralization), and 87350 (… hepatitis Be antigen (HBeAg)).

Code 87467 describes a quantitative chemiluminescent immunoassay to measure the level of HBsAg in the serum of patients being monitored for progression of chronic hepatitis B and their response to antiviral therapy, according to Cheryl James, representing Mayo Clinic Laboratories in her presentation at the Clinical Laboratory Fee Schedule annual meeting earlier this year.

Code 87467 test results quantify HBV replication to help assess the value of antiviral therapy for treating chronic HBV infection, which can lead to an increased risk of liver cirrhosis and cancer.

Don’t Forget Microorganism PLA Codes

The CPT^® 2023 manual will list several PLA codes for the first time, most of which have been effective since their release in earlier 2022 quarters. Here’s a rundown of those codes for a refresher of what you’ll find in CPT^® 2023 and report for these specific tests.

Remember: PLA codes apply to only one unique lab test made by a specific manufacturer or performed by a specific lab. PLA codes take precedence over the usual 80000 series codes for laboratory/pathology, so you must report the appropriate PLA code if you perform the proprietary test.

Infectious agent detection: Several recent PLA codes describe nucleic acid tests to identify the presence of specific infectious agents in a patient specimen using various test methodologies. Here’s a list of those codes with their effective dates and proprietary names:

• 0301U (Infectious agent detection by nucleic acid (DNA or RNA), Bartonella henselae and Bartonella quintana, droplet digital PCR (ddPCR)), effective Jan. 1, 2022; Bartonella ddPCR from Galaxy Diagnostics Inc.
• 0302U (Infectious agent detection by nucleic acid (DNA or RNA), Bartonella henselae and Bartonella quintana, droplet digital PCR (ddPCR); following liquid enrichment), effective Jan. 1, 2022; Bartonella Digital ePCR™ from Galaxy Diagnostics Inc.
• 0321U (Infectious agent detection by nucleic acid (DNA or RNA), genitourinary pathogens, identification of 20 bacterial and fungal organisms and identification of 16 associated antibiotic-resistance genes, multiplex amplified probe technique), effective April 1, 2022; Bridge Urinary Tract Infection Detection and Resistance Test from Bridge Diagnostics
• 0323U (Infectious agent detection by nucleic acid (DNA and RNA), central nervous system pathogen, metagenomic next-generation sequencing, cerebrospinal fluid (CSF), identification of pathogenic bacteria, viruses, parasites, or fungi), effective July 1, 2022; Johns Hopkins Metagenomic Next Generation Sequencing Assay for Infectious Disease Diagnostics from Johns Hopkins Medical Microbiology Laboratory
• 0353U (Infectious agent detection by nucleic acid (DNA), Chlamydia trachomatis and Neisseria gonorrhoeae, multiplex amplified probe technique, urine, vaginal, pharyngeal, or rectal, each pathogen reported as detected or not detected) effective Oct. 1, 2022; Xpert^® CT/NG from Cepheid^®

Other microorganism assays: Several PLA codes take a different approach to evaluating the clinical significance of an infectious agent. Here are other codes you’ll see for the first time in CPT^® 2023, listed with their effective dates and proprietary names.

• 0316U (Borrelia burgdorferi (Lyme disease), OspA protein evaluation, urine) effective April 1, 2022; Lyme Borrelia Nanotrap^® Urine Antigen Test
  • This test helps clinicians determine if the patient has an active case of Lyme disease.
• 0351U (Infectious disease (bacterial or viral), biochemical assays, tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), interferon gamma-induced protein-10 (IP-10), and C-reactive protein, serum, algorithm reported as likelihood of bacterial infection), effective Oct. 1, 2022; MeMed BV^® from MeMed Diagnostics Ltd.
  • This test helps determine if a patient infection is bacterial as opposed to viral, to aid in rapid determination of appropriate treatment.
• 0352U (Infectious disease (bacterial vaginosis and vaginitis), multiplex amplified probe technique, for detection of bacterial vaginosis–associated bacteria (BVAB-2, Atopobium vaginae, and Megasphera type 1), algorithm reported as detected or not detected and separate detection of Candida species (C. albicans, C. tropicalis, C. parapsilosis, C. dubliniensis), Candida glabrata/Candida krusei, and trichomonas vaginalis, vaginal-fluid specimen, each result reported as detected or not detected) effective Oct. 1, 2022; Xpert^® Xpress MVP from Cepheid^®
  • This test helps identify the infectious agent for a patient with symptoms of vaginosis/vaginitis.
• 0354U (Human papilloma virus (HPV), high-risk types (ie, 16, 18, 31, 33, 45, 52 and 58) qualitative mRNA expression of E6/E7 by quantitative polymerase chain reaction (qPCR)), effective Oct. 1, 2022; PreTect HPV-Proofer’ 7 from GenePace Laboratories
  • This test helps identify whether the patient’s HPV infection is one of the high-risk types, putting them at increased risk for cervical cancer.