Pathology/Lab Coding Alert

Question: At the request of the treating physician, our pathologist provided an interpretation and report concerning a patient's serum protein electrophoresis (84165) results. I've been told we should report the interpretation using 83912. Is this correct?

Georgia Subscriber

Answer: No, you should not use 83912 (Molecular diagnostics; interpretation and report) to report your pathologist's interpretation of 84165 (Protein; electrophoretic fractionation and quantitation, serum). Use 83912 only to describe a pathologist's interpretation and report on a molecular diagnostics study. CPT provides 83890-83913 (Molecular diagnostics ...) to describe the various steps (mostly technical) that the lab performs for molecular diagnostics.

The pathologist will interpret the study and report 83912.

Do this: If a physician requests that your pathologist interpret a serum protein electrophoresis, you should report the service as 84165 with modifier 26 (Professional component). Medicare allows you to report a professional interpretation for 18 lab tests that CMS deems likely to require such a service. Code 84165 is on that list.

To warrant reporting 84165-26, the pathologist must receive a request for the interpretation (standing orders for test results outside of an expected range will suffice), and must render a medical opinion and write a report.