Pathology/Lab Coding Alert

New edits limit your payment for multiple techniques

Labs have many methods to test for respiratory syncytial virus or Helicobacter pylori--but for either organism, you can only code one technique, according to new edit pairs.

The new code bundles found in National Correct Coding Initiative version 12.1 add to the long list of similar coding restrictions for other organisms.

“The edit pairs should not cause many problems because labs would rarely perform more than one test for a specific organism on the same day,” says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Choose Just 1 Method

In most instances when CPT lists different methods for identifying the same organism, NCCI bundles those codes. Version 12.1 adds a few new code pairs based on the same principle: NCCI now bundles 83009 (Helicobacter pylori, blood test analysis for urease activity, non-radioactive isotope [e.g., C-13]) with a different method code, 87339 (Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; Helicobacter pylori).

Similarly, NCCI bundles 87807 (Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus) with two other method codes for the same organism:

• 87280--Infectious agent antigen detection by immunofluorescent technique; respiratory syncytial virus

• 87420--Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semi-quantitative, multiple step method; respiratory syncytial virus.

Use the Most Specific Code

NCCI also pairs codes to ensure that you report only the most specific method code. “You should not use a ‘not otherwise specified’ method code instead of or in addition to a specific code for a particular organism,” Dettwyler says.

That’s why NCCI 12.1 bundles 83009 with the following codes:

• 83519--Immunoassay, analyte, quantitative; by radiopharmaceutical technique (e.g., RIA)
• 83520--… not otherwise specified
• 83788--Mass spectrometry and tandem mass spectrometry (MS, MS/MS), analyte not elsewhere specified; qualitative
• 83789--... quantitative, each specimen.

Based on the same principle, NCCI also bundles 87807 with these codes:

• 87147--Culture, typing; immunologic method, other than immunofluoresence (e.g., agglutination grouping), per antiserum
• 87797--Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; direct probe technique, each organism
• 87798--… amplified probe technique, each organism
• 87799--… quantification, each organism.