Pathology/Lab Coding Alert

Genetic test modifiers and array codes may go, too.

Despite 101 new CPT® 2012 codes, all's quiet on the molecular diagnostics front, and you're still happily reporting "stacking" codes (83890-83914, Molecular diagnostics...) just like you've always done.

But that really is all about to change. The results of the most recent CPT® Editorial Panel meeting includes the following action for CPT® 2013: "Accepted establishment of a new Category I unlisted molecular pathology procedure code (814XX9) and deletion of the molecular pathology stacking codes 83890-83914 and the related guidelines for these codes."

Background: "Because CMS failed to price the 101 new CPT® codes (81200-81048, ... molecular pathology procedures...) this year, Medicare and most other payers still use the stacking codes 83890-83914 for molecular pathology payment in 2012," says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha.

Keep in mind: Even though the proposed CPT® Editorial Panel changes have been posted online (www.ama-assn.org/resources/doc/cpt/summary-of-panel-actions-feb2012.pdf), there is no guarantee that these changes will be instituted in CPT® 2013. As the editorial panel notes indicate, "Codes are not assigned, nor exact wording finalized, until just prior to publication."

Expect Single 'Unlisted' Code

Although you've expected the deletion of 83890-83914 for 2013, the new news is that you'll have a single unlisted molecular pathology procedure code to replace those codes when you report a molecular pathology test not represented in the Tier 1 and Tier 2 codes.

Array and modifiers may go: The CPT® Editorial Panel summary report states that the change request included "deletion of codes 88384-88386 ... and ...deletion of all genetic testing code modifiers (Appendix I)," but it's not clear that the action fulfills this request.

Background: Currently, you should use 88384-88386 (Array-based evaluation of multiple molecular probes ...) instead of the stacking codes to report tests involving devices with nucleic acid probes or DNA sequences imbedded in a platform such as a slide, chip or microbeads, according Diana Voorhees, MA, CLS, MT(ASCP)SH, CLCP, principal at DV & Associates Inc., in Salt Lake City. The codes account for arrays with 11-500 probes.

Also currently available in CPT® appendix I are the genetic test modifiers that you can append to the appropriate stacking codes to help identify the specific molecular test. The system allows up to 260 two-place modifiers -- one digit (0-9) followed by one letter (A-Z). The first position designates broad groups of molecular tests, such as 2 for neoplasia/lymphoid tests and 5 for neurologic genetic tests.

Because the CPT® Editorial Panel action deletes "related guidelines" for stacking codes 83890-83914, you might expect the AMA to delete array codes and genetic test modifiers, which are referenced in the guidelines.

Expect Tier 1, Tier 2 Updates

The CPT® Editorial Panel accepted revisions to Tier 2 codes, such as "changing the number of exons in the KRAS test from two to three" for 81403.

You can also expect the "establishment of codes AXXX2, AXXX3, and AXXX4 to report adenomatous polyposis coli analysis" for CPT® 2013, according to the CPT® Editorial Panel meeting notes.