Pathology/Lab Coding Alert

Question: When performing multiple nucleic acid probes on the same specimen, can I bill a separate interpretation code for each set?
 
For example, if we extract the genetic material from the source and then run two probe sets that involve two enzymatic digestions and two gel electrophoreses for each probe, can a separate interpretation code (83912) be billed for each set? Similarly, can 83912 be billed for each primer pair of molecular amplification of nucleic acid?

Tennessee Subscriber
 
Answer: Molecular diagnostic testing, reported with 83890-83912, is used to diagnose genetic disorders that may or may not be expressed in a disease state. The methods involve extracting genetic material from various specimen sources, and isolating, manipulating and investigating specific nucleic acid sequences to detect mutations that mark a carrier or individual predisposed to a specific genetic disorder.
 
Each of the codes in the range 83890-83912 represents a single process, many of which may be used together to reach a diagnosis. Each of the steps should be reported using the appropriate code, and if any step is repeated more than once, it should be reported with the appropriate number of units.
 
The one exception is the interpretation code, 83912 (Molecular diagnostics; interpretation and report), which is generally reported once for each diagnosis, regardless of the number of tests involved in reaching that diagnosis. So whether investigating a genetic disorder that involves multiple sites of mutation or a disorder involving only one genetic marker, there would be only one final interpretation and report and, thus, only one unit of 83912 reported. Although some laboratories report the interpretation code for each probe or amplified probe, many local medical review policies (LMRPs) and reference sources link the interpretation to the final diagnosis, not to each set of tests run.
 
In the first example in the question, it would be appropriate to report 83890 (Molecular diagnostics; molecular isolation or extraction), 83892 x 4 (two for each of two probes) ( enzymatic digestion), 83894 x 4 (two for each of two probes) (  separation by gel electrophoresis) and 83896 x 2 ( nucleic acid probe, each). However, since all of these tests were required to reach a single diagnosis, it would be appropriate to report only one unit of 83912.
 
Similarly, only one unit of 83912 should be reported for the diagnosis of the genetic disorder involving multiple primer pairs for the amplified probe technique.

 
  Answers to Reader Questions and You be the Coder were answered with the assistance of Laurie A. Castillo, MA, CPC, CPC-H, CCS-P, president of Physician Coding and Compliance Consulting in Manassas, Va.; R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark.; and Kenneth Wolfgang, MT (ASCP), CPC, CPC-H, director of coding and analysis for National Health Systems Inc. in Camp Hill, Penn.