Pathology/Lab Coding Alert

Question: If the lab performs a hepatitis C qualitative PCR and an HCV RNA quantification from the same blood draw, can we report both services?


Oregon Subscriber

Answer: You would not normally report together two codes for nucleic-acid detection of the same infectious agent. Labs generally perform only one test on any given day to either identify or quantify infection with a specific organism. For example, the lab may perform a qualitative PCR for HCV RNA (amplified probe technique) to detect hepatitis C infection, and may, at a later time, perform HCV RNA quantification to monitor treatment effects. You would report the first test as 87521 (Infectious agent detection by nucleic acid [DNA or RNA]; hepatitis C, amplified probe technique) and the second as 87522 (... hepatitis C, quantification), but not on the same day. 

In fact, National Correct Coding Initiative (NCCI) edits list 87521 and 87522 as mutually exclusive codes. But hepatitis C isn't the only organism test that's bundled - NCCI lists as mutually exclusive the direct probe, amplified probe and quantification codes for each organism listed in the code range 87470-87652.

Although NCCI lists the bundled codes with a modifier indicator of "1," meaning that you can override the edit pair with a modifier, you should not do so when the lab runs the two tests on the same specimen.