Pathology/Lab Coding Alert

You wouldn't think that one simple, new syphilis test code could cause so much trouble, but 86780 is doing just that. If your lab is struggling with how to report the obstetrics panel with treponemal antibody or how to code confirmatory testing, read on.

You'll find some good news in the new syphilis test code 86780 (Antibody; Treponema pallidum). Before CPT 2010 introduced 86780, the only treponemal antibody test code was 86781 (Antibody; Treponema pallidum, confirmatory test [e.g., FTA-abs]).

Difficulty: Based on the code definition, you could only report 86781 when the physician ordered a confirmatory test following an initial syphilis test such as (86592, Syphilis test; qualitative [e.g., VDRL, RPR, ART]). But sometimes labs prefer to offer the Treponema pallidum antibody test as the initial tool for syphilis diagnosis.

"Unlike tests such as the rapid plasma reagin (RPR), labs can automate the treponemal antibody test," says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore. Many labs choose to test for Treponema pallidum as the initial syphilis screening instead of offering the RPR test first.

Do this: Whether the lab performs the antibody test as the initial syphilis screening or as a follow-up test for 86592, you should report 86780 for Treponema pallidum antibody testing because CPT 2010 deletes 86781*.

Because syphilis screening is part of the obstetrics panel, 86870 is making waves for labs that perform an automated panel that includes treponemal antibody. Look at the details of the OB panel and the new CPT text note that follows the code and you'll see why:

80055 -- Obstetric panel. The panel must include the following:

• Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR

What that means for you: "The 80055 code descriptor and CPT text note make it very clear that you should not report the OB panel if your lab performs each panel test, but tests for syphilis by treponemal antibody (86780) instead of non-treponemal antibody (86592)," Dettwyler says.

Our lab has switched to syphilis screening using treponemal antibody, and we're frustrated to think that we need to unbundle the OB panel because we perform 86780," says Janet Schroeter, MT (ASCP), laboratory compliance specialist at Fletcher Allen Health Care in Burlington, Vt. "Unbundling the panel will cost payers more."

AMA stands firm: "I don't know why the AMA didn't revise the OB test panel to include 86592 OR 86780.Adding the syphilis test option would be comparable to the current OB panel definition allowing multiple testing and coding options for the CBC," Dettwyler says. "In response to a question I submitted, the AMA stated that we could request a modification to the OB panel code descriptor -- but that would be effective no earlier than 2011."

Despite CPT instruction, you might try to overcome the OB panel/treponemal antibody obstacle by implementing internal compliance measures. "This issue may be worth the effort because reporting OB panels two different ways adds complexity for lab billing and cost for payers," Dettwyler explains.

"Component billing the tests, including 86780, will be about four times more expensive for patients and payers than the OB panel."

Action plan: "Even without a CPT change that resolves the problem, you might seek physician recommendation that it is medically appropriate to substitute 86780 for 86592 in the OB panel," Dettwyler says. "Then your compliance team might want to contact major payers including Medicaid before putting in place a billing protocol that allows using 80055, even if the panel includes the treponemal antibody test."

*Correction: Prior to final CPT 2010 release showing 86781 deletion, Pathology Lab Coding Alert in Vol. 10, No.13, page 104 (print version, not online version) erroneously stated that you should continue to report confirmatory tests with 86781.