Pathology/Lab Coding Alert

Net $$ for cell lysis and primer extension too

Confused about how many units of service to charge for multiplex reactions or how to get paid for unlisted steps in your molecular diagnostics procedures? Your answer is here -- in the form of revised and new codes for CPT Codes 2006.

Prior to the changes, labs didn't code for certain molecular diagnostics procedures such as cell lysis because CPT provided no code for the service, according to Diana Voorhees, MA, CLS, MT(ASCP)SH, CLCP, principal with DV and Associates Inc. in Salt Lake City. That's why learning how to use the revised codes can keep your billing accurate -- and help your bottom line.

Add Up Steps for Molecular Diagnostics Study

When labs perform molecular diagnostics techniques to analyze nucleic acids, you should use 83890-83914 to report the service. -Each code describes a separate technique, such as nucleic acid extraction or gene amplification, and you should report each step using the appropriate code,- explains Elizabeth Sheppard, HT(ASCP), marketing manager for Ventana Medical Systems in Tucson, Ariz.

CPT 2006 adds five codes and revises two in this code range. Physicians order molecular diagnostic testing to diagnose and direct treatment relating to infectious agents and disease markers, inherited disorders and oncology.

Clarify Unit of Service
 
New language in CPT 2006 updates 83898 (Molecular diagnostics; amplification of patient nucleic acid, each nucleic acid sequence) to remove the terminology single primer pair. -Although the change doesn't alter how you use the code, the new definition clarifies that you should code once for each nucleic acid sequence, rather than for a primer pair that is used to -flag- each sequence,- Voorhees says.

Technical note: -Amplification- involves duplicating one or more nucleic acid sequences from patient DNA to make more copies for testing. -The larger sample acquired through amplification improves the quality of testing,- Voorhees says.

CPT also clarifies the unit of service for multiplex reactions -- procedures that -amplify- more than one nucleic acid sequence in a single tube. Rather than using one unit of 83901 for each multiplex reaction, as you did prior to CPT 2006, you should now report multiplex reactions using the following new and revised codes:

- 83900 -- Molecular diagnostics; amplification of patient nucleic acid, multiplex, first two nucleic acid sequences

- +83901 -- Molecular diagnostics; amplification of patient nucleic acid, multiplex, each additional nucleic acid sequence (list separately in addition to code for primary procedure).

-The code change spells out that the unit of service for multiplex amplification is the nucleic acid sequence,- Voorhees says. The new wording overcomes some confusion with the old 83901 definition that you should use the code only once regardless of the number of nucleic acid sequences in the tube.

Don't miss: CPT 2006 changes 83901 to an add-on code, meaning that you must use it only in addition to the primary service (83900).

Old way: A cystic fibrosis carrier screen involves amplification of 15 nucleic acid sequences in a single tube. You would have reported the service under the  old definition as 83901 (Molecular diagnostics; amplification of patient nucleic acid, multiplex, each multiplex reaction).

New way: Using the 2006 codes, list the same service as 83900 for the first two nucleic acid sequences, plus 83901 x 13 for the remaining nucleic acid sequences amplified, Voorhees says.

Big pay change: The 2006 clinical laboratory fee schedule (CLFS) does not change the 83901 pay and sets the 83900 pay as double 83901. But your lab should see a pay increase for multiplex reactions -- fifteen times more in the preceding example. That's because, under the revised codes, the payment unit is each nucleic acid sequence, not each multiplex reaction.

Collect Pay for Additional Molecular Diagnostics Procedures

CPT 2006 adds four codes for procedures that  labs may perform as a component of a molecular diagnostics study:

- 83907 -- Molecular diagnostics; lysis of cells prior to nucleic acid extraction (e.g., stool specimens, paraffin embedded tissue)
- 83908 -- ... signal amplification of patient nucleic acid, each nucleic acid sequence
- 83909 -- - separation and identification by high resolution technique (e.g., capillary electrophoresis)
- 83914 -- Mutation identification by enzymatic ligation or primer extension, single segment, each segment (e.g., oligonucleotide ligation assay [OLA], single base chain extension [SBCE], or allele-specific primer extension [ASPE]).

-Before the addition of these codes, labs either used a less-specific code or didn't report these component services at all,- Voorhees says. Here's a round-up of what the new codes can do for you:

83907: When performing molecular diagnostics testing on biopsy tissue that a pathologist has fixed with formalin and embedded in paraffin, the lab must break down cellular structures before extracting and purifying nucleic acids for testing. -Prior to CPT 2006, labs did not usually code for this step in molecular diagnostics testing,- Voorhees says. Now you can report the step as 83907, which pays $18.66 on the CLFS.

83908: Although you can report 83898-83901 for amplifying nucleic acid sequences, CPT did not provide a code for amplifying the signal (the fluorescent tag for a nucleic acid) rather than the nucleic acid itself -- until now. CPT 2006 introduces 83908 to report signal amplification, which pays the same as 83898.

83909: Labs that perform capillary electrophoresis (83909) may not have reported the service in the past -- or they may have used
83894 (Molecular diagnostics; separation by gel electrophoresis [e.g., agarose, polyacrylamide]). Either way, labs gain by accurately using the new code, 83909, which pays $23.42, while 83894 pays $5.60 on the CLFS.

83914: CPT 2006 establishes 83914 because previously existing codes only described mutation detection through DNA sequencing. The new code describes mutation identification through enzyme ligation or primer extension. Report the code in addition to any other procedures involved in a molecular diagnostics study.

Beware of Double-Dipping
 
When a lab uses molecular diagnostics methods -- such as DNA extraction or probe technique -- to detect a specific infectious agent, you should report the service with the specific code from the microbiology section rather than the 83890-83914 series, Sheppard says.

For instance: The lab tests a blood specimen for a patient with suspected systemic candidiasis using a DNA direct probe technique. Report 87480 (Infectious agent detection by nucleic acid [DNA or RNA]; candida species, direct probe technique). Don't additionally report each step using the molecular diagnostics codes, such as 83896 (- nucleic acid probe, each).

Code 87480 describes the comprehensive procedure and includes every step of the process. The National Correct Coding Initiative (NCCI) bundles infectious agent and molecular diagnostics codes to ensure that you don't double-dip on these services.