Pathology/Lab Coding Alert

Warning: Infectious agent detection includes nucleic acid steps

When your lab identifies organisms using DNA or RNA tests, watch out for bundling pitfalls. The latest version of the National Correct Coding Initiative (NCCI) will steer you in the right direction.

Here's how: Choose the most specific organism code from the microbiology code family, such as 87470 (Infectious agent detection by nucleic acid [DNA or RNA] ...). You should not additionally report each of the nucleic acid lab methods--and that's where the NCCI edits come in.

NCCI version 13.1 adds edit pairs for the following molecular diagnostics codes with all codes for infectious agent detection by nucleic acid (87470-87622, 87650-87801 and 87901-87903):

- 83900--Molecular diagnostics; amplification of patient nucleic acid, multiplex, first two nucleic acid sequences
- 83907--Molecular diagnostics; lysis of cells prior to nucleic acid extraction (e.g., stool specimens, embedded tissue)
- 83908--Molecular diagnostics; signal amplification of patient nucleic acid, each nucleic acid sequence
- 83909--Molecular diagnostics; separation and identification by high-resolution technique (e.g., capillary electrophoresis).

Prior NCCI versions bundled other molecular diagnostics steps with infectious agent codes.

Bottom line: When a lab uses molecular diagnostics methods--such as DNA extraction or probe technique--to detect a specific infectious agent, you should report the service with the specific code from the microbiology section rather than the molecular diagnostics series (83890-83913), says Elizabeth Sheppard, HT (ASCP), marketing manager for Ventana Medical Systems in Tucson, Ariz.

Different Lab Methods? Pick 1

Labs often have alternative methods to arrive at the same answer -quot; and CPT provides a different code for each method.

New NCCI edit pairs enforce a basic coding principle: Pick the most specific code. You shouldn't report two methods to arrive at similar information, such as glycosylated hemoglobin tests (83036, Hemoglobin; glycosylated [A1C]; or 83037, Hemoglobin, glycosylated [A1C] by device cleared by FDA for home use).

Similarly, NCCI now bundles the following codes:

- 0140T (Exhaled breath condensate pH) with 82800 (Gases, blood, pH only) and 83986 (pH, body fluid, except blood)

- 83630 (Lactoferrin, fecal; qualitative) with 83631 (Lactoferrin, fecal; quantitative)

- 83704 (Lipoprotein, blood; quantitation of lipoprotein particle numbers and lipoprotein particle subclasses [e.g., by nuclear magnetic resonance spectroscopy]) with 83700 (Lipoprotein, blood; electrophoretic separation and quantitation)

- 86480 (Tuberculosis test, cell mediated immunity measurement of gamma interferon antigen response) with 86580 (Skin test; tuberculosis, intradermal)

- 87209 (Smear, primary source with interpretation; complex special stain [e.g., trichrome, iron hemotoxylin] for ova and parasites) with 87207 (Smear, primary source with interpretation; special stain for inclusion bodies or parasites [e.g., malaria, coccidia, microsporidia, trypanosomes, herpes viruses])

- 83900 (Molecular diagnostics; amplification of patient nucleic acid, multiplex, first two nucleic acid sequences) with 83898 (Molecular diagnostics; amplification of patient nucleic acid, each nucleic acid sequence)

- 83904 (Molecular diagnostics; mutation identification by sequencing, single segment, each segment) with 83905 (Molecular diagnostics; mutation identification by allele specific translation, single segment, each segment).