Pathology/Lab Coding Alert

Question: I’m aware that PLA codes take priority over 80000-level lab codes, but how do I find the codes, and how do I know when a test has a proprietary code?

California Subscriber

Answer: You are correct that you must use a Proprietary Laboratory Analyses (PLA) code instead of a Category I CPT^® code. In fact, PLA codes take priority over any other code that might describe a similar procedure.

You can find PLA codes several places within the CPT^® manual, which lists the codes at the end of the Pathology and Laboratory chapter, where they appear in numerical order, starting with 0001U. You’ll also find all the PLA codes listed in CPT^® Appendix O, along with codes for Multianalyte Assays with Algorithmic Analyses (MAAA) codes. The appendix also lists the codes in numerical order.

Difficulty: Because the manual doesn’t list the codes alphabetically by any organizing feature such as analyte or type of test, you can’t easily find a specific test by looking through the lists. “In other parts of the manual, such as the Chemistry section, CPT^® lists analytes alphabetically, making it easier to scan the code list for the desired test,” says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Tools: If your lab performs a PLA test purchased from the manufacturer, the test insert should inform you of the appropriate proprietary code for the test. Because the PLA codes describe only proprietary tests, you will always have the manufacturer’s information for a PLA test. You may also use an online coding tool such as Codify, available at www.aapc.com/codes/, that allows you to search for specific codes.

Update: The American Medical Association (AMA) publishes new PLA codes quarterly. You can access the complete list of PLA codes, including the most current update at www.ama-assn.org/system/files/cpt-pla-codes-long.pdf. This list will include quarterly updates that have not yet made it to the annual publication of the CPT^® manual.