Pathology/Lab Coding Alert

Question: We need help coding for Digene GC/CT testing. When the lab performs the GC/CT combo screening, we report CPT 87801 . But when the lab performs individual tests for identification of GC and CT on a positive screen, we report 87491 for Chlamydia and 87591 for gonorrhoeae. We lose money on 87801 but get decent payment for 87491 and 87591. Since these codes are for the same organisms and use the same method (nucleic acid, amplified probe), can we report the initial screening for both organisms as 87491 plus 87591?

Florida Subscriber
 
Answer: You shouldn't use 87491 (Infectious agent detection by nucleic acid [DNA or RNA]; Chlamydia trachomatis, amplified probe technique) and 87591 (... Neisseria gonorrhoeae, amplified probe technique) to report a single test that screens for both organisms. As you've been doing, the correct coding for the single Digene Hybrid Capture screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) is 87801 (Infectious agent detection by nucleic acid [DNA or RNA], multiple organisms; amplified probe[s] technique). Code 87801 describes an infectious agent test for multiple organisms, which most accurately describes the test your lab performs.

When a positive screen reflexes to individual CT and GC identification tests from the same specimen, you cannot additionally report the individual tests 87491 and 87591 for most payers. The National Correct Coding Initiative edits prohibit reporting either 87491 or 87591 with 87801.

Payment rates should never drive your coding decisions -- you should report the CPT code that most accurately describes the procedure the lab performs. Under the 2004 Clinical Lab Fee Schedule, however, the national fee limit pays virtually the same whether you perform the combined test 87801 ($100.63) or the two individual tests 87491 ($50.31) and 87591 ($50.31)."