Pathology/Lab Coding Alert

Question: Our physician office lab recently began performing the urine BladderChek test by Alere for diagnosis and monitoring of bladder cancer. We were told to bill the test as 86924, because the test is an immunoassay for bladder tumor antigen NMP22. Is this correct?

Illinois Subscriber

Answer: No, 86294 (Immunoassay for tumor antigen, qualitative or semiquantitative (e.g., bladder tumor antigen) is not the correct code for the Alere NMP22 BladderChek urine test. Instead, you should report the test using 86386 (Nuclear Matrix Protein 22 [NMP22], qualitative).

Here’s why: The BladderChek test is a qualitative urine test specifically for Nuclear Matrix Protein number 22 (NMP22). NMP22 is an abnormal protein whose presence in the urine might indicate a bladder tumor. Physicians may use the test diagnostically, or to monitor bladder cancer progress during treatment. You should always select the most specific code for a test, and in this case, that’s 86386.

The code you mentioned — 86294 — is a more general code that describes an immunoassay for tumor antigens, and may be qualitative or semi-quantitative. You would use 86294 for other immunoassay tumor antigen tests that don’t have a more specific code.

For instance: Another bladder cancer test, BTA stat, checks for a bladder tumor associated antigen that is part of the complement factor H related protein (CFHrp). This test does not check for NMP22. The correct code for this test is 86294.

To ensure that you don’t erroneously report 86294, a CPT^® text note following the code directs you to report 86386 for qualitative NMP22 protein.

Use modifier: If you’re a CLIA-waived lab, you need to use modifier QW (CLIA waived test) when you report 86386 for an NMP22 qualitative test such as Alere BladderChek. You’ll also need the modifier to report 86294 for the BTA stat test if you’re a CLIA waived lab.

Tip: Always check the CLIA waived test list to be sure that the test you’re performing is approved for your lab’s CLIA status. The list will also help you see appropriate coding based on test-kit brand name. The list is updated quarterly, and you can access the list at www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/Categorization_of_Tests.html.