Pathology/Lab Coding Alert

Make sure you know microbiology modifications that could save you $$$.

Of course you need to know the new procedure codes you-ll use starting Jan. 1, but those aren't the only CPT 2009 changes that will affect your bottom line.

In fact, some code modifications and text notes clarify when and how you should bill for multiple units of a service. That could stop you from losing pay you deserve -- such as $16.76 for many codes for infectious agent antigen detection by enzyme immunoassay (EIA), for example.

Study the following CPT 2009 changes to make sure you-re coding correctly and capturing every penny for your lab.

If your lab performs evocative/suppression testing, you know that the lab code is only part of the story.

In addition to the appropriate code from the range 80400-80440 that describes the lab component of the protocol, there should be a charge for the evocative or suppressive agent. Don't miss physician charges for administering the drugs and possibly for evaluation and management of the patient during the procedure.

Make this change to get paid: Because CPT 2009 updated the injection/infusion codes, you-ll see a reference to the new codes in the lab-section directions for evocative/suppression testing. The relevant new codes are 96360-96361 (Intravenous infusion, hydration -) and 96372-96375 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug] -). You will need to select the correct code or codes based on the administration route, the substance or drug used, and the duration, if applicable.

"If you continue to use the old injection/infusion codes that CPT 2009 removed and replaced with new codes, you won't get paid," says William Dettwyler, MT-AMT, president of Codus Medicus, a coding consulting firm in Salem, Ore.

CPT 2009 changes four codes in the chemistry section that specified "serum" as the specimen source in past CPT editions. The new code definitions specify the specimen source as "serum, plasma or whole blood."

- 82040 -- Albumin; serum, plasma or whole blood

- 84132 -- Potassium; serum, plasma or whole blood

- 84155 -- Protein, total, except by refractometry; serum, plasma or whole blood

- 84295 -- Sodium; serum, plasma or whole blood.

"Although practically, many people use these codes for any blood source, the word, -serum,- was really too restrictive," Dettwyler says. "Expanding the definition removes any uncertainty you might have about using the codes for plasma or whole blood."

Note that many other chemistry codes maintain the narrower wording, such as 82010 (Acetone or other ketone bodies; serum, quantitative) and 82435 (Chloride; blood).

"I would still say that you can use these codes that specify -serum- or -blood- with any component part of blood unless there is a specific code for that blood component," Dettwyler says.

The microbiology section sees some CPT 2009 changes, too. When your lab identifies an infectious agent from a primary source, you should select the proper code from the range 87260-87899 based on the lab method and organism. If you identify two organisms from a single source, you should report the two appropriate infectious agent identification codes.

But what if you identify two organisms that use the same code? Until now, experts may have given you different answers, but CPT 2009 sets the record straight.

Do this: According to the new text note preceding infectious agent codes, you should "use modifier 59 [Distinct procedural service] when separate results are reported for different species or strains that are described by the same code."

Caveat: Certain payers require you to use modifier 91 (Repeat clinical diagnostic laboratory test) instead of modifier 59, so follow your payer's instructions.

For example: If the lab identifies Clostridium difficile toxin A and toxin B by enzyme immunoassay (EIA), you should report 87324 for toxin A (Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; Clostridium difficile toxin[s]) and 87324-59 for toxin B. Billing for each toxin will earn you an extra $16.76 that your lab deserves, based on the Clinical Laboratory Fee Schedule national limit amount.

Another change in the 2009 infectious agent code group involves a code modification that effectively "indents" four codes as part of a larger code family: 87810 (Infectious agent detection by immunoassay with direct optical observation; Chlamydia trachomatis).

With the initial phrase preceding the semicolon in 87810, subsequent codes 87850-87899 were part of the 87810 code family in 2008.

By removing the descriptor before the semicolon and indenting 87810 under parent-code 87802 (Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group B), subsequent codes 87850-87899 also become part of that family.

"The change is a matter of semantics that makes the codes uniformly describe -infectious agent antigen detection,-" Dettwyler says. "The change shouldn't alter your code selections for these tests."

Caution: Be wary when locating the correct code in this series because the organisms are not in alphabetical order as they are for most of the other infectious agent codes.

CPT 2009 drops three category III codes that lab coders might have used in the past:

- 0026T -- Lipoprotein, direct measurement, intermediate density lipoproteins (IDL) (remnant lipoproteins)

- 0041T -- Urinalysis infectious agent detection, semi-quantitative analysis of volatile compounds

- 0043T -- Carbon monoxide, expired gas analysis (e.g., ECTOc/hemolysis breath test).

What they are: The AMA developed category III codes for new and emerging technologies, says Franz Ritucci, MD, DABAM, FAEP, director of the American Academy of Urgent Care Medicine in Orlando, Fla. And because the AMA uses the codes to gather usage data, reporting Category IIIs could contribute to creating future category I codes that will pay.

Where did they go? Category III codes don't hang around forever. They-re used for data collection, and if they become widely used, the AMA may assign a category I code with the same definition. If not, the AMA archives each category III code after five years from its inception "unless it is demonstrated that a temporary code is still needed," according to the introduction to the codes.

The AMA did not assign a category I code for any of the deleted category III lab codes this year. So if your lab still performs the test, how should you report it now?

Revert to unlisted: "If the category III code expires without converting to category I, you-ll have to go back to using the appropriate -methodology- or -unlisted- category I code to describe the test," Dettwyler advises.

For example: If your lab performs the urinalysis by analyzing volatile compounds, you should no longer report 0041T. Instead, report 81099 (Unlisted urinalysis procedure).

The AMA also made one simple change to three CPT panel codes in 2009 to clarify that a component test is "total calcium" as opposed to ionized calcium. The new code definitions add the word total to ensure that one of the tests the panel includes is "Calcium, total (82310)."

The three codes that include this change are as follows:

- 80048 -- Basic metabolic panel

- 80053 -- Comprehensive metabolic panel

- 80069 -- Renal function panel.