Pathology/Lab Coding Alert

Rarely used; gone for good?

Remember those two-place genetic testing modifiers that first appeared in CPT Appendix I in 2005? Neither does anyone else, apparently.

Despite the modifiers' availability for seven years, most payers and labs never adopted them. "We never used the modifiers, even though CPT continued to update them with additions such as new human-leukocyte antigen (HLA) modifiers in 2011," says Diana Voorhees, MA, CLS, MT(ASCP)SH, CLCP, principal at DV & Associates Inc., in Salt Lake City.

Know the Back Story

Developed by the Genetic Testing Workgroup chaired by the College of American Pathologists (CAP), the system allows up to 260 two-place modifiers -- one digit (0-9) followed by one letter (A-Z). The first position designates broad groups of molecular tests, such as 2 for neoplasia/lymphoid tests and 5 for neurologic genetic tests.

"The modifiers were supposed to be a Band-Aid® for some years until a coding system could be developed," Voorhees says. That's what we have in the 101 new Tier 1 and Tier 2 molecular pathology codes in CPT® 2012. "The new system should provide far more granularity than the modifiers allow," she says.

Beware: As labs and payers transition to using the new molecular pathology codes, a few payers may still ask for genetic testing modifiers, which you'll still find in CPT appendix I. For instance Blue Cross/Blue Shield has been known to request modifier 0A for BRCA1 for hereditary testing for ovarian and breast cancer.