Pathology/Lab Coding Alert

Consider new CCI edits your guide.

Heads up: You have new restrictions on reporting pathology consultations, infectious agent detection, and transfusion medicine.

Those are just some of the many new edit pairs youll have to maneuver in the latest Correct Coding Initiative(CCI) update if you want to protect your labs pay.

Wake Up to Large File

The second quarter is often a quiet front for CCI edits -- but not this year.

Version 15.1, effective April 1, contains 304,038 additions. The file is one of the largest Ive seen, says Barbara Cobuzzi, MBA, CPC, CENTC, CPC-H, CPCP,CIMC, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J.

With new limits on code combinations from pathology consultations to molecular diagnostics and microdissections,you need to tackle nearly 40 changes in laboratory/pathology alone.

Avoid Consultation Double-Dipping

No surprise here -- CCI already bundles hundreds of lab codes with pathology consultation 80500 (Clinical pathology consultation; limited, without review of patient'shistory and medical records) and 80502 (... comprehensive, for a complex diagnostic problem, with review of patients history and medical records).

The April 1 CCI update continues the tradition by adding edit pairs between 80500/80502 and the following three procedures:

" 86356 -- Mononuclear cell antigen, quantitative (e.g., flow cytometry), not otherwise specified, each antigen

" 87500 --  Infectious agent detection by nucleic acid (DNA or RNA); vancomycin resistance (e.g., enterococcus species van A, van B), amplified probe

" 87809 - Infectious agent antigen detection by immunoassay with direct optical observation;adenovirus.

These edits indicate that you cant bill Medicare for a pathologists medical direction and supervision of clinical lab tests under the guise of an 80500 or 80502 consultation,says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Opportunity: But that doesnt mean a pathologist cant charge for an 80500 or 80502 consultation related to lab tests such as these immunology and microbiology procedures. If the attending physician requests a consultation on an abnormal lab test result and the pathologist renders a professional opinion and files a report, you can report 80500 or 80502 with any of the bundled lab codes by appending modifier 59 (Distinct procedural service) to the consultation code.

Watch Infectious Agent Restrictions

CCI 15.1 adds more vancomycin resistance edits -- specifically, 15 pairs that bundle 87500 with molecular diagnostics codes 83890-83902 and 83907-83913 (Molecular diagnostics &). These edit pairs join hundreds of similar CCI bundles between other infectious agent detection codes and the molecular diagnostics series.

When a lab uses molecular diagnostics methods -- such as DNA extraction or probe technique -- to detect a specific infectious agent, you should report the service with the specific code from the microbiology section rather than the molecular diagnostics series (83890-83913).

Thats not all: The latest CCI version also bundles two more codes with 87500:

" 87149 --Culture, typing; identification by nucleic acid probe

" 87253 -- Virus isolation; tissue culture, additional studies or definitive identification (e.g., hemabsorption,neutralization, immunofluoresence stain), each isolate.

Code 87500 identifies both the organism and the lab method. Codes 87149 and 87253 report additional methods that labs use for definitive identification, but 87500 includes the definitive identification.

You should not report the method code in addition to the more specific organism code, Dettwyler says.

Instead, you should choose one method. Labs often have alternative methods to arrive at the same answer, and CPT provides a different code for each. The latest CCI version adds a mutually exclusive edit pair (87260,Infectious agent antigen detection by immunofluorescent technique; adenovirus; with 87809, Infectious agent antigen detection by immunoassay with direct optical observation;adenovirus) to enforce a basic coding principle -- choose the most specific code for a single test.

Hone Transfusion Medicine Distinction

CCI 15.1 adds a mutually exclusive edit pair for the following two transfusion medicine codes:

" 86885 -- Antihuman globulin test (Coombs test);indirect, qualitative, each reagent red cell

" 86850 -- Antibody screen, RBC, each serum technique.

These two codes basically describe the same test,Dettwyler says.

Although you might commonly use 86850 for an obstetrics panel antibody screen, the procedure is anindirect Coombs test, Dettwyler explains.

You should select one code or the other for an antibody screen, but you might report multiple units if you use more than one serum technique or reagent red cell.

Protect yourself: CCI version 15.1 took effect April 1. You can access the edits online at www.cms.hhs.gov/NationalCorrectCodInitEd/.