Pathology/Lab Coding Alert

Frustrated microbiologists will rejoice to learn that National Correct Coding Initiative (NCCI) edits, version 9.1, remove troublesome edit pairs for anaerobic and aerobic stool and "other source" cultures. The Medicare bundling has cost many labs denials for 87075 (Culture, bacterial; any source, anaerobic with isolation and presumptive identification of isolates) when performing commonly accepted tests such as aerobic and anaerobic wound cultures.

Medicare no longer considers 87075 a component of 87046 (Culture, bacterial; stool, additional pathogens, isolation and preliminary examination [e.g., Campylobacter, Yersinia, Vibrio, E. coli 0157], each plate) or 87070 (Culture, bacterial; any other source except urine, blood or stool, with isolation and presumptive identification of isolates) in NCCI 9.1

"Removing these edit pairs is good news because when labs perform an anaerobic culture, microbiology protocol calls for performing an aerobic culture as well," says William Dettwyler, MT-AMT, coding analyst for Health Systems Concepts, a laboratory coding and compliance consulting firm in Longwood, Fla. With the removal of the edit pairs, labs should again expect Medicare to pay for these services when provided together for medically necessary purposes.

Medicare also deleted nearly 200 other pathology and laboratory edit pairs in NCCI 9.1. Most of these were "housekeeping" removals, involving codes that were deleted in CPT 2003. NCCI 9.1 removes edit pairs involving old hematology and cytopathology codes, for example.