Pathology/Lab Coding Alert

Apply CPT 2006 codes like a pro

You-ve just read about how to properly use molecular diagnostics codes. Now put what you-ve learned to use with the following scenarios. Then check our expert's solution to find out if you really know your molecular diagnostics codes.

Scenario 1: Following surgical pathology examination of a lymph node, the pathologist sends the paraffin-fixed specimen for T-Cell Receptor (TCR) gene rearrangement assay to aid in diagnosing T-cell malignancy. The lab lyses cells from the paraffin-embedded tissue, extracts purified DNA and amplifies genes from the V and J regions of the T-cell receptor gamma chain gene. The process involves amplification of two separate nucleic acid sequences and multiplex reactions to amplify 24 other sequences in a single tube. The lab then uses high-resolution capillary electrophoresis to evaluate the amplified genes and report on the presence of a TCR-gamma clonal expansion that might suggest T-cell malignancy.

Solution 1: For lymph-node cell lysis prior to DNA extraction, report 83907 (Molecular diagnostics; lysis of cells prior to nucleic acid extraction [e.g., stool specimens, paraffin embedded tissue]). Report the extraction as 83891 (Molecular diagnostics; isolation or extraction of highly purified nucleic acid).

List CPT 83898 x 2 (Molecular diagnostics; amplification of patient nucleic acid, each nucleic acid sequence) for amplifying the two individual gene sequences. Also report 83900 (Molecular diagnostics; amplification of patient nucleic acid, multiplex, first two nucleic acid sequences) plus 83901 x 22 (Molecular diagnostics; amplification of patient nucleic acid, multiplex, each additional nucleic acid sequence [list separately in addition to code for primary procedure]) for the multiplex reactions.

Use 83909 (Molecular diagnostics; separation and identification by high resolution technique [e.g., capillary electrophoresis]) to code for the high-resolution identification technique. For the pathologist's interpretation and report on findings from the molecular diagnostics study, use 83912-26 (Molecular diagnostics; interpretation and report). If the hospital bills only a technical component of 83912, report the code without modifier 26 (Professional component).

Scenario 2: The lab receives whole blood from a pregnant patient with a family history of factor V Leiden thrombophilia. The lab method involves DNA isolation and purification, as well as fluorescence amplification of a specific nucleic acid sequence. Detection involves using two specific nucleic acid probes to identify G-to-A substitution in nucleotide 1691 from the factor V gene.

Solution 2: Use 83891 to report the isolation and purification of nucleic acid sequences. List 83908 (Molecular diagnostics; signal amplification of patient nucleic acid, each nucleic acid sequence) for the nucleic acid sequence signal amplification. Report 83896 x 2 (Molecular diagnostics; nucleic acid probe, each) for the probes, and 83912-26 for pathologist interpretation of the study.

Note: Molecular diagnostics solutions were prepared with the assistance of Diana Voorhees, MA, CLS, MT(ASCP)SH, CLCP, principal with DV and Associates Inc. in Salt Lake City.