Don't report flow cytometry with immunology, cytopathology
If you want to code 2005's new flow cytometry and morphometric analysis codes with confidence, you'll need to know how to maneuver edit pairs in the latest National Correct Coding Initiative edits (version 11.0). NCCI 11.0 took effect Jan. 1. You can access the edits online at www.cms.hhs.gov/physicians/cciedits/default.asp.
CPT Codes 2005 deleted flow cytometry code 88180 and replaced it with five new codes:
88184 - Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker
+88185 - ... each additional marker (list separately in addition to code for first marker)
88187 - Flow cytometry, interpretation; 2 to 8 markers
88188 - ... 9 to 15 markers
88189 - ... 16 or more markers. Now NCCI restricts how you can use these codes. Because CPT also added three new cell-count immunologycodes that you previously reported using a flow-cytometry code, NCCI 11.0 clarifies coding for these services. "You should not report both immunology and flow cytometry codes for a single procedure," says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.
Don't miss: NCCI 11.0 bundles flow cytometry codes 88182-88184 and 88187-88189 with quantitative immunology codes. The NCCI Policy Manual states, "Quantitative cell counts performed by flow cytometry (codes 86064 [B cells, total count], 86359-86361 [T cells; ...], 86379 [Natural killer (NK) cells, total count], and 86587 [Stem cells (i.e., CD34), total count]) should not be reported with the flow cytometry interpretation CPT codes 88187-88189 since there is no interpretative service for these quantitative cell counts."
Watch for: NCCI 11.0 also adds edit pairs to clarify that for a single specimen, you shouldn't report flow cytometry codes with the following nongynecology cytopathology codes:
88108 - Cytopathology, concentration technique, smears and interpretation (e.g., Saccomanno technique)
88112 - Cytopathology, selective cellular enhancement technique with interpretation (e.g., liquid-based slide preparation method), except cervical or vaginal
88160 - Cytopathology, smears, any other source; screening and interpretation
88161 - ... preparation, screening and interpretation
88162 - extended study involving over 5 slides and/or multiple stains. Although pathologists might perform both cytopathology - to examine cell morphology - and flow cytometry - to study cellular surface-marker antigens - this NCCI edit prohibits billing both services together.
"Even if the pathologist performs two distinct procedures, you should not override the edit with modifier -59 (Distinct procedural service) if you only have one specimen," Dettwyler says.
