Pathology/Lab Coding Alert

Question: When our lab performs an hCG test on maternal blood for pregnancy, what code should we report?

Tennessee Subscriber

Answer: You should probably report the test you describe as 84703 (Gonadotropin, chorionic (hCG); qualitative). The fact that the test specimen is maternal blood rules out another common pregnancy test using a urine specimen: 81025 (Urine pregnancy test, by visual color comparison methods).

However, CPT^® provides other codes for hCG testing that typically use maternal blood as the specimen, and your question doesn’t give enough information to rule those out.

For instance: If the lab performs a quantitative hCG test, you should turn to 84702 (Gonadotropin, chorionic (hCG); quantitative). Clinicians may order this test instead of the qualitative test if they need additional information, such as an indication of fetal age, ectopic pregnancy, or miscarriage.

Labs may perform a different hCG test for free beta chain (84704, Gonadotropin, chorionic (hCG); free beta chain) to indicate fetal genetic abnormalities such as Down syndrome or trisomy 18.

PLA: If the lab performs the proprietary hCG test, ADEXUSDx^® hCG Test by NOWDiagnostics, Inc., the correct code is 0167U (Gonadotropin, chorionic (hCG), immunoassay with direct optical observation, blood). Proprietary laboratory analyses (PLA) codes refer to a specific test provided by a specific lab or manufacturer and take priority over any Category 1 CPT^® code that may also fit the test descriptor.