Pathology/Lab Coding Alert

Stop using Q0111 for fecal leukocyte exam

CPT 89055 is out of limbo -- you should use it to report a fecal leukocyte exam even if you're a provider-performed microscopy (PPM) lab. Clinical Laboratory Improvement Amendments (CLIA) certification rules had foiled PPM labs' attempts to use 89055 since its introduction in CPT 2003.

CPT 2004 eliminated "leukocyte count" from the 89055 definition (Leukocyte assessment, fecal, qualitative or semiquantitative), so if you're a PPM lab, you no longer have to report a fecal leukocyte exam with Q0111 (Wet mounts, including preparations of vaginal, cervical or skin specimens), according to CMS.

PPM Labs Can't 'Count'

CPT 2003 added new code 89055 (Leukocyte count, fecal). Concurrent with the advent of 89055, CMS deleted HCPCS Level II code G0026 (Fecal leukocyte examination), intending for 89055 to serve as a possible replacement code. In fact, the AMA stated in "CPT Changes 2003, An Insider's View," that "new code 89055 correlates with HCPCS Level II G code G0026, Fecal leukocyte examination."

No so fast. Under CLIA rules, PPM certification allows a fecal leukocyte exam but does not include a leukocyte count. PPM labs can only perform PPM or waived procedures, so CLIA certificate-level edits precluded PPM labs from using 89055, according to CMS. That left PPM labs with no code for reporting fecal leukocyte exams.

"CMS issued a program memorandum [AB-03-127] instructing PPM labs to use existing code Q0111 to report fecal leukocyte exams until it resolved the coding dilemma," says Kenneth Wolfgang, MT (ASCP), CPC, CPC-H, director of coding and analysis for National Health Systems Inc., a coding consultation company in Camp Hill, Pa.

Code Q0111 describes wet mount preparations, and the fecal leukocyte exam is a form of wet mount examination, according to the memo. Medicare carriers should have accepted Q0111 for fecal leukocyte exams billed by PPM labs for dates of service during 2003. You can access the CMS program memo on the Internet at http://www.cms.gov/manuals/pm_trans/AB03127.pdf.

CMS Revives 89055 for PPM Labs

CPT 2004 amended 89055 to describe a nonquantitative test that does not involve a leukocyte count. The revision meets the CLIA definition of the PPM procedure for fecal leukocyte examination.

"CMS has instructed contractors to accept 89055 from facilities with a valid PPM procedure CLIA certificate,"  Wolfgang says. The change was effective Jan. 1, 2004. You can access the notification on the Internet at http://www.cms.hhs.gov/manuals/pm_trans/R12CP.pdf.

"Remember that Q0111 is still a valid code for PPM labs, but you should only use it for wet mounts of tissues such as vaginal, cervical, or skin specimens," Wolfgang says. "Discontinue using Q0111 to report the PPM fecal leukocyte exam."