Pathology/Lab Coding Alert

Watch for metabolic panel, immunology and more

A new -unlisted antigen- code should clarify your immunology reports, and a new basic metabolic panel code will simplify reporting a specific group of chemistry tests. You-ll see these changes and more in the list of new CPT codes unveiled by CMS in time for its July 16 public pricing forum.

Study the following chart to get a preview of what's in store for your lab coding in 2008. Although the AMA assigned codes in time for the meeting, the numbering is not finalized.

Use New Panel for Ionized Calcium

Because ionized calcium may have clinical significance in patients with kidney or liver disorders, physicians may want to test this blood component in addition to other chemical factors of the basic metabolic panel. You-ll have a new code to report a basic metabolic panel with ionized calcium (instead of calcium) in 2008.

Old way: Under CPT 2007, if a lab performs the basic metabolic panel but measures ionized calcium (82330) instead of calcium (82310), you should report each separate component (82330, Calcium; ionized; 82374, Carbon dioxide; 82435, Chloride; 82565, Creatinine; 82947, Glucose; 84132, Potassium; 84295, Sodium; 84520, Urea nitrogen [BUN]).

New way: Starting in 2008, report the service as 80047 (Basic metabolic panel [Calcium, ionized]).

Watch for pay: Lab groups varied in their payment recommendations for 80047. While some (such as ASCP and CAP) recommended a crosswalk to 80048 for $11.83, others recommended a crosswalk to ATP07 (Automated test panel pricing code, 7 tests) for $11.42 plus 82330 for $19.09 (total $30.51).

Because labs must use separate instrumentation for the ionized calcium in addition to the seven tests of the metabolic panel (minus calcium), CLMA believes that ATP07 together with 82330 represent an accurate picture of the work involved in the panel, says Katharine Ayres, MT (ASCP), CT, director of legislative and regulatory affairs for CLMA.

Move Your Search for Unlisted Antigen to Cell-Count Codes

When labs perform immunodeficiency panels, you should report each specific cell count using immunology codes 86355-86367. If the panel includes an unlisted antigen, you have to look elsewhere in CPT for the code.

Old way: Through the end of 2007, you should list 86586 (Unlisted antigen, each) when an immunodeficiency panel includes an unlisted antigen.

New way: Beginning in 2008, you should report the same service as 86356 (Unlisted antigen, each). The change effectively -moves- the unlisted code within the series of specific cell-count codes for immunodeficiency testing (86355-86367).

Look for Final CMS Pricing in the Fall

As you can see from the table, CPT 2008 adds other chemistry, microbiology and immunology codes to describe testing for antibiotic resistance, irritable bowel syndrome, and adenovirus infection, among others.

CMS will announce lab fees by Sept. 7 but will allow additional comments for two weeks. Look for the final pricing on the Clinical Laboratory Fee Schedule, which CMS says it will make available on the Internet by mid-November at www.cms.hhs.gov/ClinicalLabFeeSched/.