Pathology/Lab Coding Alert

Don't report G0306-G0307 and 88361 with component tests

If you want to code 2004's new blood count and morphometric tumor analysis codes with confidence, you'll need to know how to maneuver edit pairs in the latest National Correct Coding Initiative edits (version 10.0).
 
NCCI 10.0 took effect Jan. 1. You can access the edits at http://www.cms.hhs.gov/physicians/cciedits/default.asp.

Watch Out for CBC G Code Bundles

CMS added two new G codes in 2004 for complete blood counts (CBC) without platelets, and as a result, NCCI 10.0 introduced 25 new edit pairs involving codes G0306 (Complete [CBC], automated [Hgb, Hct, RBC, WBC, without platelet count] and automated differential WBC count) and G0307 (Complete [CBC], automated [Hgb, Hct, RBC, WBC, without platelet count]).
 
"You'll have to know about these edit pairs and how to override them if you want to get paid when your lab legitimately performs a CBC followed by a separate blood count for the same patient on the same day," says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore. See "Remember Blood Count Bundles With This Clip-and-Save Chart" in this issue for a complete list of the edit pairs.

"NCCI 10.0 bundles the CPT codes for each component test with G0306 and G0307," Dettwyler says. Although you should not unbundle and separately report a component test from G0306 or G0307, you may have to override the edit pair and separately report a component code if the lab repeats a component test later in the day. For example, if the lab performs a CBC and differential without platelets and later the same day performs a medically necessary hemoglobin for a Medicare patient, you should report 85018 with modifier -91 (Repeat clinical diagnostic laboratory test) in addition to G0306.
 
You can override most G0306 or G0307 component-test bundles, including hematocrit (85013, 85014), hemoglobin (85018), red blood cells (85041) and white blood cells (85048), because NCCI 10.0 lists them with modifier indicator "1." But you cannot separately report a differential white blood count (WBC) with G0306 using any modifier because NCCI pairs G0306 with codes 85004, 85007, 85008 and 85009 using a modifier indicator of "0."
 
"NCCI 10.0 also bundles G0306 and G0307 with other CBC codes, and lists a 0 modifier prohibiting overriding these edits," Dettwyler says. That means you can't report G0306 and G0307 together, or either G code with 85025 or 85027, even if the lab performed the tests at separate encounters on the same day. 
 
You also shouldn't report either G0306 or G0307 with an automated platelet (85049), according to NCCI 10.0. "Instead, if the lab performs complete CBC and platelets, you should report 85025 with differential, or 85027 without," Dettwyler says.

Don't Mix and Match ISH Codes

NCCI 10.0 also places restrictions on coding for fluorescence in situ hybridization (FISH or ISH) testing. The edit software prohibits reporting 88365 (Tissue in situ hybridization, interpretation and report) with the following molecular cytogenetics codes:

 

 88271 - Molecular cytogenetics; DNA probe, each (e.g., FISH)
 

 88272 - ... chromosomal in situ hybridization, analyze 3-5 cells (e.g., for derivatives and markers)
 

 88273 - ... chromosomal in situ hybridization,  analyze 10-30 cells
 

 88274 - ... interphase in situ hybridization,  analyze 25-99 cells
 

 88275 - ... interphase in situ hybridization,  analyze 100-300 cells.

The restriction affirms coding experts' assertions that you should not use these codes together for the same test, but that you should report 88365 for FISH or ISH performed on tissue samples and report codes 88271-88275 for non-tissue samples. (See "Think You're Coding FISH Procedures Correctly? Not if You Aren't Following These Rules," in the  October 2003 Pathology/Lab Coding Alert.) "Since the codes describe different sample sources, you should not report them together to describe any single ISH analysis," says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha.
 
Similarly, you should no longer report 88365 with 88358 (Morphometric analysis; tumor [e.g., DNA ploidy]). Although opposed by the College of American Pathologists, CMS implemented this edit pair, claiming that 88365 includes both a qualitative and quantitative assessment contrary to CAP's interpretation.
 
CMS added the 88365/88358 edit pair at the same time that CPT changed the definition of 88358 and added a new code, 88361 (Morphometric analysis; tumor immunohistochemistry [e.g., Her-2/neu, estrogen receptor/progesterone receptor], quantitative or semiquantitative). Coders previously reported 88365 and 88358 together when pathologists performed breast tissue Her-2/neu as well as quantitative or semiquantitative tumor immunohistochemistry to evaluate a patient's suitability for Herceptin therapy. "Now you should report 88365 and 88361 for those services," Slagle says.

88361 Includes IHC Stain

In a related edit, NCCI 10.0 prohibits reporting together 88361 and 88342 (Immunohistochemistry [including tissue immunoperoxidase], each antibody), which concurs with the CPT note following 88361 that states, "Do not report 88361 with 88342 unless each procedure is for a different antibody." The 88361 service includes the immunohistochemistry (IHC) stain. Before CPT added 88361, coders reported 88358 and 88342 to describe IHC and morphometric analysis with a  pathologist's interpretation. "After an earlier NCCI version added an edit pair for 88358 and 88342, coders had no way to report the full quantitative IHC service until CPT added 88361," Slagle says.

Override Creatinine Edit for Different Sources

Because 82575 (Creatinine; clearance) includes a urine creatinine, you should never report an additional 82570 (Creatinine; other source) for the urine test. NCCI 10.0 clarifies this restriction by adding an edit pair for 82575 and 82570. If the lab performs a creatinine for a source other than urine, such as peritoneal fluid, on the same day as a creatinine clearance, you'll have to override the edit pair by appending modifier -59 (Distinct procedural service) to 82570. NCCI 10.0 also bundles 82565 (Creatinine; blood) with 82575.

Lab Service Often Includes Specimen Prep

For some lab services that require special specimen collection and handling, NCCI 10.0 bundles those procedures. For example, NCCI bundles cell freezing and thawing (G0265, Cryopreservation, freezing and storage of cells for therapeutic use, each cell line; and G0266, Thawing and expansion of frozen cells for therapeutic use, each aliquot) with flow cytometry codes 88180 (Flow cytometry; each cell surface, cytoplasmic or nuclear marker) and 88182 (... cell cycle or DNA analysis).
 
Similarly, you shouldn't report a specimen collection 81050 (Volume measurement for timed collection, each) with a creatinine clearance test (82575) that requires the volume measurement, according to NCCI 10.0. This code pair has a modifier indicator of 0, meaning that you cannot under any circumstances override the edit.
 
When physicians perform gastric and duodenal intubation and aspiration procedures (89100-89105 and 89130-89141), NCCI 10.0 bundles the code for the tube placement (43752, Naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance [includes fluoroscopy, image documentation and report]). Similarly, the edits bundle certain upper gastrointestinal endoscopy codes (43237, 43238) with 89130 (Gastric intubation and aspiration, diagnostic, each specimen, for chemical analyses or cytopathology).