Pathology/Lab Coding Alert

Question: Our lab performs the obstetrics panel, but we use the automated treponemal antibody test to screen for syphilis. How should we code this?

Wisconsin Subscriber

Answer: CPT^® provides two obstetric panel codes, so the first thing you need to do is define which panel you’re performing. Code 80081 includes an HIV test, while 80055 does not.

CPT^® lists which lab tests each panel “must include” for you to be able to use one of those codes. The code definition and test lists are as follows:

80081 Obstetric panel (includes HIV testing)
This panel must include the following:
Blood count, complete (CBC), and automated
differential WBC count (85025 or 85027 and 85004)
OR
Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009)
Hepatitis B surface antigen (HBsAg) (87340)
HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result (87389)
Antibody, rubella (86762)
Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART) (86592)
Antibody screen, RBC, each serum technique (86850)
Blood typing, ABO (86900) AND
Blood typing, Rh (D) (86901)

80055 Obstetric panel
This panel must include the following:
Blood count, complete (CBC), automated and automated differential WBC count (85025 or
85027 and 85004)
OR
Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009)
Hepatitis B surface antigen (HBsAg) (87340)
Antibody, rubella (86762)
Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART) (86592)
Antibody screen, RBC, each serum technique (86850)
Blood typing, ABO (86900) AND
Blood typing, Rh (D) (86901).

Key: CPT^® emphasizes that the panel codes are “for coding purposes only, and should not be interpreted as clinical parameters.” That means clinicians are free to order, and labs are free to perform, a slightly different group of tests than those listed in a CPT^®  panel code. If that’s the case, you should not report the panel code if the lab, but should instead separately list the tests you do perform.

Because both 80050 and 80081 include the non-treponemal antibody test, you should not report either code if you perform the treponemal antibody test for syphilis screening.

Do this: List the codes for each test you perform, such as 86780 (Antibody; Treponema pallidum), 85025, 87340, 86762, 86900, and 86901.

Plus: If the syphilis test is one of the proprietary laboratory analyses (PLA) tests, you must use the appropriate PLA code rather than a Category I CPT^®  code. You’ll find the following two PLA syphilis test codes in CPT^®  2020:

• 0064U (Antibody, Treponema pallidum, total and rapid plasma reagin (RPR), immunoassay, qualitative)
• 0065U (Syphilis test, non-treponemal antibody, immunoassay, qualitative (RPR)).