Pathology/Lab Coding Alert

Prep for new, specific microbiology codes.

You can never start too early to learn about what procedure code options are coming down the pike for your lab to use next year.

Stakeholders got a preview of the codes and recommended pricing at the Clinical Laboratory Fee Schedule (CLFS) Annual Public Meeting held June 23, 2022. Read on to get a peek inside the meeting’s revelations.

Key: The American Medical Association (AMA) hasn’t finalized the 2023 CPT^® code numbers, but the Centers for Medicare & Medicaid Services (CMS) provides the code definitions for stakeholder comment. The open meeting is part of the process to determine the basis of payment for the codes, according to CMS’ meeting facilitator, Rasheeda Arthur, PhD.

Check Out New Microorganism Codes

CPT^® 2023 will provide four new codes describing tests for specific pathogens, as follows:

• 8X009 (Infectious agent detection by nucleic acid (DNA or RNA); Anaplasma phagocytophilum, amplified probe technique)
• 8X010 (… Babesia microti, amplified probe technique)
• 8X011 (… Borrelia miyamotoi, amplified probe technique)
• 8X012 (Ehrlichia chaffeensis, amplified probe technique)

Until these new organism-specific codes go into effect, you should continue reporting these tests with existing code 87798 (Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism).

HBsAg: You’ll find the following new microbiology code for quantitative Hepatitis B surface antigen testing: 8X002 (Hepatitis B surface antigen (HBsAg), quantitative).

“There is no comparable existing test that describes a quantitative chemiluminescent enzyme immunoassay to measure the level of Hepatitis B surface antigen in the serum of patients being monitored for progression of chronic Hepatitis B and their response to antiviral therapy,” according to Cheryl James, representing Mayo Clinic Laboratories in her presentation at the annual meeting.

Look for Wide-Ranging GSP Tests

CPT^® 2023 will include six new codes in the Genomic Sequencing Procedure (GSP) section describing tests for conditions ranging from cancers to drug metabolism.

GSPs simultaneously evaluate multiple genes related to a specific condition or diagnosis. The tests may use neoplasm specimens to evaluate somatic (not inherited) mutations associated with specific cancers. Or the assays may use specimens such as buccal (cheek) swab or blood to evaluate germline (inherited) mutations associated with conditions such as cystic fibrosis. The tests often use next generation sequencing (NGS), which is an automated instrument that can simultaneously determine the order of DNA or RNA nucleotides in many genes and use bioinformatics to interpret the results.

Here are the new code descriptors:

• 8X000 (Drug metabolism (eg, pharmacogenomics) genomic sequence analysis panel, must include testing of at least 6 genes, including CYP2C19, CYP2D6, and CYP2D6 duplication/deletion analysis)
• 814XX (Inherited bone marrow failure syndromes (IBMFS) (eg, Fanconi anemia, dyskeratosis congenita, Diamond-Blackfan anemia, Shwachman- Diamond syndrome, GATA2 deficiency syndrome, congenital amegakaryocytic thrombocytopenia) sequence analysis panel, must include sequencing of at least 30 genes, including BRCA2, BRIP1, DKC1, FANCA, FANCB, FANCC, FANCD2, FANCE, FANCF, FANCG, FANCI, FANCL, GATA1, GATA2, MPL, NHP2, NOP10, PALB2, RAD51C, RPL11, RPL35A, RPL5, RPS10, RPS19, RPS24, RPS26, RPS7, SBDS, TERT, and TINF2)
• 814X1 (Targeted genomic sequence analysis panel, solid organ neoplasm, 5-50 genes (eg, ALK, BRAF, CDKN2A, EGFR, ERBB2, KIT, KRAS, NRAS, MET, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, if performed; RNA analysis)
• 814X2 (Targeted genomic sequence analysis panel, hematolymphoid neoplasm or disorder, 5-50 genes (eg, BRAF, CEBPA, DNMT3A, EZH2, FLT3, IDH1, IDH2, JAK2, KRAS, KIT, MLL, NRAS, NPM1, NOTCH1), interrogation for sequence variants, and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; RNA analysis)
• 814X3 (Targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm or disorder, 51 or greater genes (eg, ALK, BRAF, CDKN2A, CEBPA, DNMT3A, EGFR, ERBB2, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MLL, NPM1, NRAS, MET, NOTCH1, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; RNA analysis)
• 81445 (Targeted genomic sequence analysis panel, solid organ neoplasm, 5-50 genes (eg, ALK, BRAF, CDKN2A, EGFR, ERBB2, KIT, KRAS, NRAS, MET, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, if performed; DNA analysis or combined DNA and RNA analysis)

Brace for PLA Code Explosion

The AMA releases new Proprietary Laboratory Analyses (PLA) codes every quarter, so the annual CPT^® manual necessarily includes active codes. This year’s annual public CLFS meeting involved basis-of-payment discussions for nearly 70 PLA codes that will first appear in the CPT^® 2023 manual. Most recommendations continue to be for crosswalking payment to existing codes that use similar lab methods and resources.

We’ve covered many of these codes in prior issues of Pathology/Lab Coding Alert, such as “Sort Out Options for Constitutional Disorder Testing” in Volume 23, Number 6.

Extra, Extra: Read About Digital Slides

The AMA released 13 new Category III codes on July 1, 2022, that labs need to know. These codes were not part of the annual public meeting agenda, but you can review the descriptors at www.ama-assn.org/system/files/cpt-category3-codes-long-descriptors.pdf.

The codes, ranging from +0751T through +0763T (Digitization of glass microscope slides …), describe technical work involved in scanning glass slides to create digital images that the pathologist will evaluate for primary diagnosis. These are add-on codes that you’ll report in addition to the primary surgical pathology procedure code. Look to future issues of Pathology/Lab Coding Alert for more information on these codes.