Proceed With Unbundling These Tests on Same DOS
Question: Can CPT® 81270 be billed together with 87522 on the same date of service (DOS)? AAPC Forum Participant Answer: CPT® code 81270 (JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) gene analysis, p.Val617Phe (V617F) variant) describes a lab test designed to detect a change in the JAK2 gene. The gene is involved in blood cell production, and the mutation can be responsible for such conditions as Crohn’s disease, essential thrombocythemia, polycythemia vera, primary myelofibrosis, myeloproliferative disorders, and other conditions caused by abnormal blood cell production. The National Correct Coding Initiative (NCCI) views 87522 (Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification, includes reverse transcription when performed) as a Column 2, or component code for 81270, so the two codes are subject to a procedure-to-procedure (PTP) edit. However, the NCCI has assigned the edit a modifier indicator of 1, meaning you can override the edit with a NCCI-associated modifier. So, you can bill both codes on the same DOS by appending a modifier such as 59 (Distinct procedural service) to 87522. This will allow the edit to be bypassed, which will enable you to be paid for both services. Don’t forget: Make sure you provide documentation to justify the need for the patient to have both lab services performed on the same DOS. Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC
