Pathology/Lab Coding Alert

Question: Our lab runs a flow cytometry panel consisting of CD3 (total T cells), CD4, CD5, CD8, CD10, CD14, CD16/56 (NK cells), CD19 (B cells), CD20, CD23, CD45, kappa, and lambda to evaluate for lymphoma. We’re getting denials when we bill 86359 for T cells, 86355 for B cells, 86357 for NK cells, and 86356 x 10 for the remaining cell types. How should we bill this panel?

Texas Subscriber

Answer: The codes you describe are for total cell counts for immunology tests, as follows:

• 86359 — T cells; total count
• 86355 — B cells, total count
• 86357 — Natural killer (NK) cells, total count
• 86356 — Mononuclear cell antigen, quantitative (e.g., flow cytometry), not otherwise specified, each antigen.

Do this instead: For flow cytometric immunophenotyping to evaluate potential lymphoma, as you described, you should select the appropriate codes from the following list:

• 88184 — Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker
• +88185 — … each additional marker (List separately in addition to code for first marker)
• 88187 — Flow cytometry, interpretation; 2 to 8 markers
• 88188 — … 9 to 15 markers
• 88189 — … 16 or more markers.

For your example, you should code 88184 plus +88185 x 12 because your panel consists of 13 markers.

Capture interpretation: Additionally, you should report 88188 for your pathologist’s interpretation and report of the lymphoma flow cytometry panel.